Objective To explore the feasibility, safety, and clinical significance of laparoscopic cholecystectomy guided by the bile duct (LCGBD).

Methods The clinical data of 456 patients underwent laparoscopic cholecystectomy (LC) from March 2013 to April 2017 were analyzed retrospectively. The surgical dissection of the Calot's triangle was initially performed from the caudal to the cephalic along the right edge of the common bile duct and common hepatic duct. After all the structures, including the cystic duct, cystic artery, and bile duct, were distinctly exposed, the cystic duct was clipped and cut near its junction with bile duct. Resection of the cystic artery was afterwards performed. The gallbladder was ultimately resected when the above procedures were finished.

Results Of the 456 patients, 451 patients (98.9%) were successfully treated with LCGBD. Five patients (1.1%) failed to undergo LCGBD because of tight adhesion in the Calot's triangle, Mirrizzi syndrome, bile duct variation, or hemorrhage of gallbladder bed. Totally, 75 patients were found with biliary tract variations, 32 cases with minute stones in the cystic duct. No sever complication occurred, such as bile duct injury, bile leakage, major intraperitoneal hemorrhage, or reoperation. Two patients were converted to open laparotomy because of biliary tract variation or hemorrhage of gallbladder bed. There were 3 patients with post-operation abdominal residual infection, 2 patients with subxiphoid trocar wound infection. All patients with infection were cured with conservative therapy. The postoperative follow-up time ranged from 3 to 45 months, with an average of (25.1±14.6) months. There were no patients with biliary stricture or residual calculus.

Conclusions LCGBD is an effective, feasible, and safe method in facilitating the dissection of the Calot's triangle and discovery of anatomical variations, and is beneficial to reduce the incidences of biliary duct injury, hemorrhage, and other sever surgical complications.