Laparoscopic Bile Duct Exploration: How We Do It? A 5-Year-Experience Report

Cholelithiasis is a very common pathology in the world, with Mexico being one of the countries with the highest prevalence, affecting approximately 27% of the female population. It is also known that the coexistence of cholelithiasis and choledocholithiasis occurs in approximately 15% of cases, in which case a simultaneous surgical approach is possible: cholecystectomy and biliary tract exploration. Furthermore, it is reported that approximately 10% of patients with choledocholithiasis present as "difficult stone," in which the endoscopic approach is ineffective, making a surgical approach necessary. Therefore, surgery is essential in cases when the biliary tract needs to be explored. Hence, the purpose of this study is to demonstrate our experience with the minimally invasive surgical approach for choledocholithiasis using transductal bile duct exploration.

Between January 2020 and May 2025, 29 consecutive patients underwent minimally invasive biliary tract exploration surgery at our hospital; from these, 26 cases were included. Information regarding the demographics of patients, comorbidities, number of previous endoscopic retrograde cholangio-pancreatographys (ERCPs) before surgery, preoperative diagnostic workup, therapeutic interventions, details of minimally invasive transductal bile duct exploration, and postoperative outcomes, including morbidity and mortality, was recorded retrospectively.

We recorded 29 patients who underwent bile duct exploration; from these, 26 patients with choledocholithiasis were operated on with minimally invasive transductal bile duct exploration (TD-BDE) (22 laparoscopic, 4 robotic). Women represented 65.3% of the cases. The median age was 54 years (range 31-87). The median operative time was 181 minutes (range 75-310) and bleeding 125 mL (range 10-350); 21 cases (80.7%) include cholecystectomy in the same procedure. Oral intake was started in the first 48 hours. A bile leak occurred in 1 case (3.8%). There was 1 patient who needed a new ERCP 2 years after surgery because of bile duct stenosis. None of the patients required re-intervention. No mortality was recorded. The maximum follow-up was 36 months (range 1-36).

TD-BDE is a therapeutical option for choledocholithiasis, especially for "difficult stone" cases, with low morbidity and mortality. Furthermore, the benefits of minimally invasive approaches, either laparoscopic or robotic, seem to be feasible and safe; and also ERAS programs can be established considering the multidisciplinary approach of patients.