Review of the Evidence for Laparoscopic Bile Duct Exploration (LBDE)

Abstract

Currently, there is no consensus for the optimal treatment of common bile duct (CBD) stones with gallbladder in situ. Guidelines from the British Society of Gastroenterology (BSG) do not report a superiority in efficacy, morbidity or mortality, between laparoscopic cholecystectomy with intraoperative cholangiogram (LC-IOC) ± laparoscopic bile duct exploration (LBDE) and preoperative or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by LC [1]. NICE guidelines recommend the single-stage management LC-IOC ± LBDE, but only provided that the necessary expertise are available [2]. There are 4 strategies available for the management of CBD stones with gallbladder in situ: pre-operative ERCP + LC; LC + LBDE; LC + intra-operative ERCP and finally LC + post-operative ERCP. Multiple randomised control trials (RCT) have been performed in the last 20 years comparing these 4 treatments followed by numerous systematic reviews in the last 10 years (Tables 2.1, 2.2 and 2.3) trying to identify the best management strategy for choledocholithiasis with concomitant gallstones [3–14].KeywordsLaparoscopic common bile duct explorationLaparoscopic bile duct explorationEndoscopic retrograde cholangiopancreatographyCommon bile duct stonesCholedocholithiasisBile leakPancreatitis