Laparoscopic exploration can salvage failed endoscopic bile duct stone extraction

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Hepatobiliary Surgery

Background:

• Endoscopic retrograde cholangiopancreatography (ERCP) is a standard treatment for common bile duct stones (CBDS).
• Failed endoscopic stone extraction (ESE) historically led to open surgery.
• Laparoscopic common bile duct exploration (LCBDE) is an alternative for CBDS treatment.

Purpose of the Study:

• To evaluate the feasibility of LCBDE as a salvage procedure after failed ESE.
• To assess the short-term outcomes of LCBDE in this patient cohort.

Main Methods:

• Retrospective review of a prospective database.
• Analysis of patients undergoing LCBDE following unsuccessful ERCP.
• Categorization of LCBDE approaches: transcystic versus choledochotomy.

Main Results:

• LCBDE was performed on 43 patients; 15 had failed ESE.
• Successful stone clearance was achieved in 14 of 15 patients who underwent LCBDE after failed ESE.
• The median length of stay for patients with failed ESE was 3 days, compared to 2 days for the entire cohort.

Conclusions:

• LCBDE is a safe and effective salvage option for CBDS when ESE fails.
• LCBDE offers successful stone clearance and a short hospital stay.
• Availability of surgical expertise is crucial for implementing LCBDE as a salvage procedure.