Outcomes Following Common Bile Duct Exploration versus Endoscopic Stone Extraction Before, during and after Laparoscopic Cholecystectomy for Patients with Common Bile Duct Stones

Abstract

Introduction: Common bile duct exploration (CBDE) and endoscopic retrograde cholangio-pancreatography (ERCP) are two methods of retrieving common bile duct (CBD) stones. There is debate as to the best method for removal of CBD stones. The aim of this study was to compare outcomes following CBDE and/or ERCP. Methods: Data were collected retrospectively for patients undergoing CBDE and/or ERCP at a single centre from 2008-2018. Patients were grouped based on initial operative plan (single stage CBDE, pre-operative-, intra-operative-, or post-operative ERCP). Complication rates (minor Clavien-Dindo 1/2, major Clavien-Dindo 3/4), success, number of procedures, and length of stay were recorded. Results: Of 678 patients, 578 patients received CBDE first and 100 patients received ERCP as primary care. Pre-operative ERCP was associated with a significantly higher number of complications (minor 24% and major 18%) and lower success. The CBDE and post-op ERCP groups had similar morbidity (minor 5.2% vs 6.1%, and major 5.0% vs 5.0%). However, there was a significantly higher median number of procedures for post-op ERCP and longer length of stay. When both ERCP and CBDE were used there was significantly higher major (20.7%) and minor complications (27.6%). Conclusion: Pre-operative ERCP for stone clearance is associated with significantly high morbidity and had similar rates to those who failed initial treatment and underwent both CBDE and ERCP. Although morbidity and mortality for CBDE and post-operative ERCP groups are similar, post-operative ERCP is associated with longer length of stay and higher number of procedures, suggesting patient and economic advantages in single stage CBDE.