Outcome of Laparoscopic Common Bile Duct Exploration After Failed Endoscopic Retrograde Cholangiopancreatography: A Comparative Study.

Abstract

Background: Common bile duct stones (CBDS) are treated with endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) or with the single-stage laparoscopic common bile duct exploration (LCBDE) and LC. Multiple ERCP attempts and failure increase the risk of postprocedural complications. In such circumstances surgery is advocated. The aim of the study is to compare the outcome of LCBDE and LC in patients who had never had an ERCP, to that of patients who underwent previously failed ERCP. Methods: A retrospective analysis of 54 patients undergoing LCBDE and LC between 2010 and 2017, was performed. Patients were divided in 2 groups: primary surgery (group 1), surgery after failed ERCP (group 2). Demographics and preoperative investigation results were collected. Comparative outcomes were common bile duct (CBD) clearance rate, operative time, conversion to open rate, postoperative morbidity, mortality, and hospital stay. Data were evaluated with the Student's t, Chi-square, or Fisher's tests. Results were considered as statistically significant when P < .05. Results: In both groups CBD clearance was above 90%. The mean operative time was longer in group 2 (130.3 minutes ± SD 83.72 vs. 178.73 ± 57.22; P < .05). There was no difference in the conversion to open and postoperative complication rates between groups. A bile leak occurred in 2 patients from group 1, 3, from group 2. No postoperative mortality occurred. The median hospital stay was longer in group 2 (2 days ± SD 2.54 vs. 5 ± 5.77; P < .05). Conclusions: LCBDE and LC is safe and effective in patients who had previous failed ERCP. If ERCP failure is anticipated and/or the risk of post-ERCP complications is high, surgery should be considered as the first-line treatment of CBDS. Longer intraoperative time and hospital stay are expected.