Indications for a laparoscopic common bile duct exploration in a community hospital setting: a review of a single-center's experience with laparoscopic common bile duct exploration in the current decade

Abstract

Objective: Although laparoscopic cholecystectomies and IOC have become the standard, LCBDE haven't gained universal popularity despite increasing enthusiasm within the literature, pre-operative ERCP remains the procedure of choice. In the last few years there's been an increase in LCBDE in our large multi-disciplinary institution with gastroenterologists skilled in ERCP. We reviewed operative experience determining the prevalence, indications, success rates, techniques of LCBDE, and training of those surgeons performing them. Methods: Review of a prospective operative database at KP Riverside between 2010 and 2015 identified 20 LCBDE out of 5800 cholecystectomies, 25% in the first two years, and 50% in the last two, reflecting an increasing trend. The most common indication being choledocholithiasis in gastric bypass patients (55%), and failed ERCP (45%). Results: All 20 explorations were attempted transcystically, three required a choledochotomy to remove large stones. A T-Tube was placed laparoscopically through the choledochotomy in two and one had a laparoscopic choledochoduodenostomy for suspected ampullary stenosis. Laparoscopic clearance of CBD stones whether transcystic or in conjunction with choledochotomy was 85% (17/20). Of successful transcystic explorations, choledochoscopy was used in 30%. The most common technique was basket retrieval (40%), although a Seldinger technique using a glidewire and dilator/sheath under fluoroscopy was used successfully (30%). Conclusion: LCBDE with cholecystectomy was successful in the majority of patients when a team approach was undertaken. Despite the initial enthusiasm for LCBDE, it remains an uncommon procedure within our facility where skilled endoscopists are available. However, based on the results of our study LCBDE is an important technique to know.