Use of laparoscopic common bile duct exploration for failed endoscopic bile duct stone extractions

Endoscopic retrograde cholangiopancreaticography is likely the most widely chosen option for common bile duct stone treatment. Previous abdominal surgery types, especially Billroth II gastrectomy, the failure of cannulation and stone removal and the morbidity associated with open surgery have paved the way for considering laparoscopic common bile duct exploration. The aim of this study was to present our early experiences with a special emphasis on the utility of laparoscopic common bile duct exploration in choledocholithiasis patients in whom endoscopic retrograde cholangiopancreaticography failed as a treatment.

The study enrolled a total of 32 patients in the Okmeydani Training and Research Hospital with common bile duct stones who were offered laparoscopic common bile duct exploration in situations where endoscopic retrograde cholangiopancreaticography failed from March 2010 to April 2012 were analyzed prospectively.

Choledochoscopy was performed in all of the patients with the transcholedochal route, and the common bile duct stones were successfully extracted in 31 patients. There were two postoperative complications and one conversion to open surgery. The two patients with complications developed a bile leak that resolved spontaneously with observation. Due to dense adhesions and the abundance of stones in the common bile duct, only one case required open surgery, and a choledochoduodenostomy was performed.

Undoubtedly, both endoscopic retrograde cholangiopancreaticography and laparoscopic common bile duct exploration must be considered for bile duct stone treatment; however, laparoscopic common bile duct exploration can be a savior for failed endoscopic bile duct stone extraction in experienced hands.