EP.TH.594Is Laparoscopic Common bile duct exploration feasible after failed ERCP?

Abstract

Abstract Aims Concomitant gallstones and common bile duct stones are a common problem with no consensus on the best management approach. Our aim is to review the outcomes of laparoscopic clearance of common bile duct stones after failed ERCP. Methods We retrospectively studied all cases that had a failed ERCP prior to surgery in 200 cases of laparoscopic cholecystectomy with common bile duct exploration performed between 2006 and 2019. Results Twenty-two patients underwent a laparoscopic common bile duct exploration after failed ERCP. Seventeen of these were before 2013. Eleven (50%) of these were after at least one failed attempt at clearance. In 8 patients (32%) the duct was not accessible (failed cannulation) due to a variety of reasons. Nine patients had large and impacted stones, two patients had Mirrizi syndrome with concomitant CBD stones, 2 had multiple stones and one a missed stone discovered intraoperatively. CBD clearance was successful in 19 patients (88%), 8 were completed by a transcystic approach and 14 by a transcholedochal approach. Post-operative length of stay was 12 (±10) days. 1 patient had an unplanned re-admission within 30 days. 1 patient required re-operation for bleeding. 3 patients developed recurrent stones and 1 developed a subsequent stricture. No mortalities were recorded. Conclusions Laparoscopic common bile duct exploration is feasible and safe as a secondary procedure after failed ERCP. New technologies and advancements in surgical techniques will continue to improve success and morbidity.