Laparoscopic common bile duct exploration for managing difficult common bile duct stones after failed endoscopic retrograde cholangiopancreatography.

Introduction: This retrospective cohort study evaluated the efficacy of laparoscopic common bile duct exploration (LCBDE) for managing difficult common bile duct stones (CBDSs) in patients with failed endoscopic retrograde cholangiopancreatography (ERCP).

Patients and methods: Forty-two patients underwent LCBDE between 2019 and 2024, after unsuccessful ERCP. The causes of ERCP failure include cannulation failure, large stones, impacted stones and multiple stones. The surgical technique involved a standard 4-port laparoscopic cholecystectomy with an additional port for manipulation of the Fogarty catheter or choledochoscope. Stones were extracted by milking the CBD, using a Fogarty balloon catheter or with the aid of a choledochoscope. The choledochotomy was closed primarily or over the stent using interrupted or continuous sutures.

Results: The mean CBD diameter was 14.8 mm (range: 12-33 mm), with 31 patients having single stones and 11 having multiple stones. Two patients were suspected to have CBD strictures. CBD clearance was achieved in 38 (90.5%) patients. In four patients, the procedure was converted to open because of an impacted stone. Post-operative complications included bile leak (n = 2) and residual stones (n = 2). It was also observed that primary closure of the choledochotomy without drainage does not affect the outcome.

Conclusion: This study demonstrated that LCBDE is a safe and effective minimally invasive option for managing difficult CBDS when ERCP fails.