Hybrid Laparoendoscopic-Radiologic Procedure for Laparoscopic Cholecystectomy Complicated With Choledocolithiasis

The removal of common bile duct stones (CBDS) is routinely performed as either a 1-stage or 2-stage procedure. Despite many developments in both methods, the optimal approach has not been established to date. This study aimed to investigate the value and short-term outcomes of hybrid laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) combined with intraoperative endoscopic nasobiliary drainage (IO-ENBD) after primary duct closure (PDC) and intraoperative cholangiography (IOC) in patients with concomitant gallbladder stones (GBS) and CBDS.

Forty-seven patients with GBS and CBDS who underwent LC and LCBDE, PDC with IO-ENBD, and IOC were retrospectively enrolled. Stone characteristics and removal, operative data, and postoperative outcomes were recorded and analyzed.

A total of 46 (97.87%) procedures were completed without conversion to open surgery. The mean operating time was 127.15±8.36 minutes (range, 97 to 158 min). Three patients (6.38%) had residual stones during IOC but achieved 100% stone clearance eventually. Postoperative pancreatitis and bile leakage rates were 4.26% and 2.13%, respectively.

A hybrid procedure combining LC and LCBDE, PDC with IO-ENBD, and IOC is safe and feasible for concomitant GBS and CBDS.