Objective: To compare the efficacy, feasibility and safety of laparoscopic transcystic common bile duct exploration (LTCBDE) and laparoscopic common bile duct exploration (LCBDE) in treatment of common bile duct stones.   
Methods: The relevant studies publicly published from 2009 to 2019 were collected by searching several national and international databases. After literature screening according to the predefined criteria, Meta-analysis was performed by Stata12.0 SE software. 
Results: A total of 21 studies were finally included, involving 3 804 patients with 1 939 cases in LTCBDE group and 1 865 cases in LCBDE group. The results of Meta-analysis showed that the stone clearance rate in LTCBDE group was significantly higher than that in LCBDE group (OR=1.51, 95% CI=1.02–2.25, P=0.038), and the perioperative variables that include intraoperative blood loss (MD=–54.16, 95% CI=–101.07––7.26), operative time (MD=–27.27, 95% CI=–35.20––19.33), postoperative tube retention time (MD=–1.97, 95% CI=–2.32––1.63), length of hospital stay (MD=–3.04, 95% CI=–3.58––2.51) and hospitalization cost (MD=–3 554.99, 95% CI=–4 209.66––2 900.32) in LTCBDE group were all superior to those in LCBDE group (all P<0.05); the incidence rates of postoperative bile leakage (OR=0.28, 95% CI=0.19–0.40), cholangitis (OR=0.33, 
95% CI=0.14–0.80), biliary stricture (OR=0.32, 95% CI=0.11–0.91) and the overall complications (OR=0.33, 95% CI=0.25–0.43) in LTCBDE group were all significantly lower than those in LCBDE group (all P<0.05), and no significant differences were noted in the incidence rates of postoperative pancreatitis (OR=0.56, 95% CI=0.24–1.32) and biliary tract injury or bleeding (OR=0.64, 95% CI=0.24–1.71) between the two groups (both P>0.05).
Conclusion: For common bile duct stones, LTCBDE is safer and more effective than LCBDE. So, it is recommended to be used in clinical practice.