Feasibility and outcome of transcystic laparoscopic common bile duct exploration as first-line treatment for common bile duct stones: a retrospective cross-sectional study.

Abstract

Background: For treatment of common bile duct stones (CBDS), guidelines recommend a one-stage approach, including laparoscopic common bile duct exploration (LCBDE) or intraoperative endoscopic retrograde cholangiopancreatography (intraERCP). Studies show favourable outcomes with transcystic LCBDE (tLCBDE), but this technique is not widely adopted. The use of tLCBDE may be limited by several factors, but to what degree is unknown. The aim of this study is to examine the feasibility and, secondarily, outcomes of tLCBDE for patients undergoing removal of CBDS and laparoscopic cholecystectomy (LC) when tLCBDE is the first-line treatment.

Method: A retrospective cross-sectional study including patients with removal of CBDS and LC at Horsens Regional Hospital during June 2017-March 2022. We classified patients into three groups: tLCBDE, preoperative ERCP (preERCP), and other procedures. The reasons for not performing tLCBDE were registered from medical charts. In the tLCBDE and the preERCP group, we registered clearance rate, postoperative complications, and subsequent ERCP.

Results: In total, 229 patients received a procedure due to CBDS, of which 73% were emergency procedures. The groups were as follows: 179 (78%) tLCBDE, 25 (11%) preERCP, and 25 (11%) other procedures. preERCP was chosen due to the patient being unfit for emergency surgery, tLCBDE not being technically possible, and other reasons. Other procedures were chosen, because tLCBDE was not technically possible, lack of equipment or qualified surgeon, and other reasons. In the tLCBDE group, 94% of patients with CBDS were cleared, 5.6% had a complication of Clavien-Dindo grade ≥ 3, and 3.9% patients needed a subsequent ERCP.

Conclusion: tLCBDE is feasible, safe, and effective treatment which can be performed in the majority of patients with CBDS and should be considered an equivalent to ERCP or choledochotomy as first-line treatment of patients with CBDS. As some patients require ERCP or choledochotomy, tLCBDE should not be the sole treatment available.