Reclaim the duct! Laparoscopic common bile duct exploration for the acute care surgeon.

Abstract

Laparoscopic common bile duct exploration (LCBDE) has emerged as a viable and effective alternative to the traditional multistage management of choledocholithiasis involving preoperative or postoperative endoscopic retrograde cholangiopancreatography (ERCP). Despite its advantages, LCBDE remains underused, particularly among trauma and acute care surgeons, due to its technical challenges and limited training opportunities. This practical review examines advancements in LCBDE technology, exploring its clinical applications, outlining key steps for its successful implementation, and evaluating selected current literature. Multiple studies have demonstrated that LCBDE achieves comparable success rates to ERCP and reduces hospital length of stay, overall costs, and the need for additional procedures. However, barriers to widespread adoption persist, primarily related to the technical learning curve, limited exposure during surgical training, and institutional workflow constraints favoring ERCP. With recent advancements in surgical technology and enhanced training models, LCBDE is becoming increasingly adoptable. Given their frequent management of biliary abnormality, trauma and acute care surgeons should develop proficiency in this technique to optimize patient outcomes and minimizing procedural burden.