Laparoscopic exploration of common bile duct in difficult choledocholithiasis

Abstract

This is a retrospective review of the role of laparoscopic exploration of common bile duct (LECBD) in the management of difficult choledocholithiasis performed in our centre during the period 1995–2003. 97 LECBDs were performed during this period. Twenty‐five of them were performed for difficult choledocholithiasis. Difficult choledocholithiasis was defined as those which ERCP failed to retrieve because of various reasons including access and cannulation difficulty (7), difficult nature of the common bile duct (CBD) stones (16) and presence of endoscopic retrograde cholangiopancreatography (ERCP) related complications (2). Altogether 2 transcystic duct explorations and 23 choledochotomies were performed. Mean operative time was 149.4 ± 49.3 min and there were three conversions (12%). Stone clearance rate was 100% and no recurrence was detected upon a mean follow‐up of 16.8 months. Only five complications were encountered which included three bile leak and two wound infections. When the results were compared to the remaining 72 LECBD for non‐difficult stone during the same period, the complication rate, conversion rate and residual stone rate were similar despite longer operation time (149.4 ± 49.4 min vs 121.6 ± 50.5 min, P=0.025)Conclusion: LECBD is the solution to difficult CBD stones where ERCP is impossible or stone retrieval is incomplete.