Laparoscopic Common Bile Duct Exploration in a Rural Community

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Endoscopy
• Surgical Education

Background:

• Choledocholithiasis management has shifted from surgical exploration to endoscopic retrograde cholangiopancreatography (ERCP).
• This shift increases hospital stays, costs, and rural hospital transfers for ERCP.
• General surgery residents receive limited training in laparoscopic common bile duct exploration (LCBDE).

Purpose of the Study:

• To evaluate the safety, efficacy, and efficiency of laparoscopic transcystic common bile duct exploration (LCBDE).
• To assess the feasibility of performing LCBDE in a rural community setting.
• To determine the added operative time and complications associated with LCBDE.

Main Methods:

• Retrospective study of 69 consecutive LCBDE procedures performed between 2017 and 2022.
• Procedures were performed by two general surgeons in a rural community hospital.
• Outcomes included successful cannulation, stone clearance, operative time, and complications.

Main Results:

• Successful duct cannulation was achieved in 97% of cases, with 82% successful stone clearance.
• LCBDE added a median of 24 minutes to the operative time.
• No significant complications (pancreatitis, bile leak, bleeding, bile duct injury) were reported.

Conclusions:

• Laparoscopic transcystic common bile duct exploration is a safe, efficient, and successful procedure.
• Basic instrumentation, including guidewires and balloon dilators, is sufficient for LCBDE.
• Residency training reform is needed to reintroduce LCBDE into general surgery practice, reducing costs and length of stay.