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

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Hepatobiliary Surgery

Background:

• Cholelithiasis is highly prevalent globally, particularly in Mexico, affecting ~27% of women.
• Coexisting choledocholithiasis occurs in ~15% of cholelithiasis cases, often requiring simultaneous surgical intervention.
• Approximately 10% of choledocholithiasis cases present as 'difficult stones,' where endoscopic retrograde cholangio-pancreatography (ERCP) is ineffective, necessitating surgical exploration.

Purpose of the Study:

• To evaluate the efficacy and safety of a minimally invasive surgical approach for treating choledocholithiasis.
• To demonstrate experience with transductal bile duct exploration (TD-BDE) as a surgical technique for bile duct stone removal.

Main Methods:

• Retrospective analysis of 26 consecutive patients who underwent minimally invasive TD-BDE between January 2020 and May 2025.
• Data collected included patient demographics, comorbidities, prior ERCP attempts, diagnostic workup, surgical details, and postoperative outcomes (morbidity, mortality).

Main Results:

• Minimally invasive TD-BDE was performed on 26 patients (65.3% female, median age 54) using laparoscopic (22) or robotic (4) approaches.
• Median operative time was 181 minutes, with a median blood loss of 125 mL. Cholecystectomy was combined in 80.7% of cases.
• Low morbidity was observed, with one bile leak (3.8%) and one late bile duct stenosis requiring ERCP. No mortality or re-intervention was recorded.

Conclusions:

• Transductal bile duct exploration (TD-BDE) is a feasible and safe therapeutic option for choledocholithiasis, particularly for difficult stone cases.
• Minimally invasive laparoscopic or robotic TD-BDE demonstrates low morbidity and mortality rates.
• The study supports the integration of ERAS (Enhanced Recovery After Surgery) programs with a multidisciplinary approach for patients undergoing TD-BDE.