Objective To investigate the best pathway of laparoscopic surgery for choledocholithiasis. Methods According to MRCP,the cystic duct was divided into four types.The thick-straight type (n =89)and the thin-crooked type (n =65)patients randomly received the laparoscopic operations via the cystic duct or com-mon bile duct.The operation time,transit operation rate,complication rate and length of hospital stay after opera-tion were analysed.Results There were 46 cases of the thick-straight type via cystic duct,43 cases via common bile duct.The former had shorter operation time and hospital stay after operation (P <0.05),but there was no significant difference in transit operation rate and complication rate.There were 32 cases of the thin-crooked type via cystic duct and 33 cases via common bile duct and there were significant differences in the operation time, transit operation rate,complication rate and length of hospital stay after operation(P <0.05).Conclusion Ac-cording to different types,LCTBDE is suitable for the patients with thick-straight type,and LCHTD can be per-formed in thin-crooked type.Therefore,it can maximize the advantage of minimally invasive surgery.

MRCP can be applied to display three-dimensional morphology of the biliary tract clearly.Laparoscopic surgery via cystic duct for choledocholithiasis possesses obvious advantages, but it is not suitable for all cases because there are great variations in the cystic duct.So how to make proper choice of the therapeutic strategy becomes very important.In this prospective study, different surgeries were administrated in patients with common bile duct stone based on the 4 categories of cystic ducts in 96 cases judged by MRCP images.These findings demonstrated that according to the cystic duct morphological type,LCTBDE is suitable for thick-straight type, and LCBDE is fit for thin-crooked type.Be careful to choose laparoscopic surgery in the other two types considering their individual features.Thus, this classification will be propitious to maximize the advantage of laparoscopic operation as a minimally invasive treatment.