Outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography versus primary LCBDE for managing cholecystocholedocholithiasis

Abstract

Objective This study was performed to compare the outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography (ERCP) versus primary LCBDE for managing cholecystocholedocholithiasis. Methods We retrospectively analyzed data from 59 patients who underwent LCBDE during laparoscopic cholecystectomy (LC) for managing cholecystocholedocholithiasis from January 2013 to August 2019. The patients underwent either primary LCBDE plus LC (Group I) or LCBDE plus LC after failed ERCP (Group II). The demographics, reason for ERCP failure, perioperative details, and postoperative outcomes were evaluated. Results CBD stone removal using preoperative ERCP failed in 31 patients (Group II) because of remaining stones after ERCP (n = 9), failed cannulation (n = 6), failed sedation (n = 6), a periampullary diverticulum (n = 5), previous Billroth II gastrectomy (n = 3), a huge stone (n = 1), and an impacted stone (n = 1). The CBD stone clearance rate was >96% in both groups. The mean operative time, hospital stay, overall complication rate, and open conversion rate were not significantly different between the two groups. Conclusions When extraction of CBD stones by ERCP is likely to be difficult or fail, primary LCBDE is an acceptable alternative treatment for managing cholecystocholedocholithiasis.

Differences in Outcome and Comparison of Stress and Immune Status in Patients with Recurrent Common Bile Duct Stones after Biliary Tract Surgery Choosing Three Procedures (ERCP, OCBDE, and LCBDE) for Treatment

“…Therefore, the treatment is significantly more difficult and the surgical risk is greater compared with the first surgery [ 2 , 3 ]. Currently, the main secondary surgical procedures commonly used for these patients are endoscopic retrograde cholangiopancreatography (ERCP) [ 4 ], open common bile duct exploration (OCBDE) [ 5 ], and laparoscopic common bile duct exploration (LCBDE) [ 6 ], but there is no unified conclusion on which procedure is more effective. In order to provide more guidance on the treatment options for patients with recurrent common bile duct stones after biliary surgery, this study compares the differences in the application of these three procedures in 115 patients, and the results are summarized below.…”

Systematic Review and Meta-analysis of Laparoscopic Common Bile Duct Exploration in Patients With Previous Failed Endoscopic Retrograde Cholangiopancreatography

“…Five studies [33][34][35][36][37] reported bile leakage, and no noticeable difference was found between 2 groups (OR: 1.14; 95% CI: 0.58-2.23; P = 0.70; Fig. 3B).…”

“…Data regarding conversion were recorded in 5 studies, [32][33][34]36,37 in favor of either group was observed (OR: 1.09; 95% CI: 0.43-2.76; P = 0.85; Fig. 2B).…”

Recent Technical Developments in the Field of Laparoscopic Surgery: A Literature Review

“…Common bile duct (CBD) stones are one of the conditions where general surgeons commonly use LC. Although advanced laparoscopic surgical skills are necessary to conduct the operation, single-stage laparoscopic CBD exploration (LCBDE) during LC is currently predominantly utilized to treat cholecystocholedocholithiasis [28]. However, it was reported by Connor and Garden that the incidence of bile duct injury is slightly higher in LC compared to the open technique [29].…”