Review for 10.1186/s12876-025-04063-y (2025)

Title: Comparative Clinical Outcomes of Transcystic vs. Transductal Laparoscopic Common
Bile Duct Exploration: A Retrospective Study
Version: 0 Date: 14 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While retrospective studies provide valuable insights, they are inherently prone to biases such
as selection bias or incomplete data. The lack of randomization may make it difficult to account
for all potential confounders or biases that might influence the outcomes.
-The study mentions monitoring for complications like bile leakage, pancreatitis, and residual
stones. However, the specific methods for detecting and categorizing these complications are
not detailed. It would be beneficial to include more information on how complications were
identified and managed, as well as the grading or severity of complications.
-The study focuses on short-term outcomes like hospitalization metrics and immediate
postoperative complications. However, long-term follow-up data (e.g., recurrence of stones,
long-term biliary function, quality of life) would provide a more comprehensive understanding
of the advantages and drawbacks of each surgical approach.
-While hospitalization costs are measured, there is limited discussion on the broader cost-
effectiveness of TC-LCBDE versus TD-LCBDE. The cost analysis could be expanded to include
aspects such as longer-term care, readmissions, or the potential for further interventions.
-The study was conducted in a single hospital (First Affiliated Hospital of Dali University).
Although the sample size is reasonable, the findings may not be fully generalizable to
other settings, particularly in hospitals with different levels of resources, expertise, or patient
populations.
-Both techniques (TC-LCBDE and TD-LCBDE) require highly skilled surgeons, and it is not
clear whether the experience or expertise of the surgical team could influence the outcomes. A
more thorough discussion of the surgical team’s experience and any potential learning curve
effects could be valuable.
-While the discussion mentions the advantages of TC-LCBDE in reducing complications such
as bile leakage, pancreatitis, and biliary tract infections, it does not explore in detail the
specific rates of these complications in the study population. A more thorough analysis of
postoperative outcomes, including complications specific to TC-LCBDE versus TD-LCBDE,
would be valuable for providing a clearer picture of the safety of each technique.
-The discussion primarily focuses on short-term outcomes such as recovery time and hospital
stay. However, there is little mention of long-term follow-up outcomes, such as the recurrence
of common bile duct stones, patient quality of life post-surgery, or long-term complications like
biliary strictures. Including these would provide a more complete understanding of the benefits
and potential drawbacks of TC-LCBDE.
-The discussion primarily focuses on short-term outcomes such as recovery time and hospital
stay. However, there is little mention of long-term follow-up outcomes, such as the recurrence
of common bile duct stones, patient quality of life post-surgery, or long-term complications like
biliary strictures. Including these would provide a more complete understanding of the benefits
and potential drawbacks of TC-LCBDE.
-The discussion assumes that TC-LCBDE is a superior option for most patients with common
bile duct stones. However, patient variability (e.g., comorbidities, age, surgical history) is not
fully addressed in the context of TC-LCBDE. A deeper exploration of how different patient
factors may influence the choice between TC-LCBDE and TD-LCBDE would be beneficial.