Treatment for recurrent choledocholithiasis: endoscopic? or laparoscopic? A prospective cohort study

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Hepatobiliary Surgery

Background:

• Bile duct stones (choledocholithiasis) require effective management.
• Recurrent cases present unique challenges for treatment.
• Endoscopic and laparoscopic techniques are key management options.

Purpose of the Study:

• To evaluate initial experiences with endoscopic (ERCP/EST) and laparoscopic (LCBDE) treatments for recurrent bile duct stones.
• To compare the efficacy and long-term complication rates of these two approaches.
• To assess the impact on stone recurrence and stone-free intervals.

Main Methods:

• Prospective study of 153 patients with recurrent common bile duct stones (2014-2017).
• Patients underwent either ERCP/EST (n=84) or LCBDE (n=69).
• Data collected included comorbidities, symptoms, stone clearance, and short/long-term complications.

Main Results:

• Comparable stone clearance rates between ERCP/EST (94.2%) and LCBDE (91.7%).
• Similar short-term complication rates for both groups.
• LCBDE demonstrated a significantly longer stone-free interval (43.3 months vs. 28.5 months) and lower recurrence rates (11.6% vs. 26.1%) compared to ERCP/EST.

Conclusions:

• Laparoscopic common bile duct exploration (LCBDE) is a safe and effective treatment for recurrent choledocholithiasis.
• LCBDE extends the stone-free interval and reduces the risk of stone recurrence.
• Minimally invasive laparoscopic surgery offers significant advantages for managing recurrent bile duct stones.