An auspicious experience with laparoscopic common bile duct exploration

Abstract

Background and aim Common bile duct (CBD) stones are the second most common complication of gallbladder stones. The best management of patients with it remains controversial. The aim of this study was to evaluate the methods, operative time, failure rate, complications, and hospital stay of laparoscopic common bile duct exploration (LCBDE). Patients and methods This prospective study was conducted on 30 patients with CBD stones through 2 years. CBD stricture was excluded. We used transcystic or transcholedochotomy approaches for LCBDE either with or without choledoschopic guidance. Primary repair of the choledochotomy incision was done. Results The mean age was 48.90±11.84 years. Biliary colic was the presentation in 63.3% of patients, 20% presented with jaundice while 16.7% presented with both jaundice and right hypochondrial pain. The transcystic approach for CBD exploration was used in 16 cases without conversion; 11 cases completed without a choledochoscope, while five cases with choledochoscopic-guided extraction. Choledochotomy approach had been used in 13 cases, six cases completed with a choledochoscope and seven cases without it, two of them failed. One case failed from the beginning and went for open exploration. Five previously inserted stents through endoscopic retrograde cholangiopancreatography were removed. The mean operative time was 162.33±74.67 min. Transcholedochotomy approach takes longer time than transcystic. Bile leakage occurred in two cases following the choledochotomy approach. The mean hospital stay was 3.37±1.38 days. The hospital stay increased with long operative time and postoperative complications, especially bile leakage. Conclusion LCBDE is an auspicious approach to CBD stones. It is a feasible, effective, and safe procedure, depending on proper training and gaining experience. The availability of adequate equipment is mandatory and can avoid the drawbacks of endoscopic retrograde cholangiopancreatography and open CBD exploration.