Related Experiment Video
Updated: Aug 12, 2026
Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
Cost-Effectiveness of Laparoscopic Common Bile Duct Exploration Versus Endoscopic Retrograde Cholangiopancreatography
Tess Howard1, Lily Owens1, Harendra Maneesha De Silva1
1Division of Surgery, Northern Health, Epping, Victoria, Australia.
Background:
The optimal management of common bile duct (CBD) stones in the emergency setting remains debated, with both laparoscopic common bile duct exploration (CBDE) and endoscopic retrograde cholangiopancreatography (ERCP) commonly employed. This study compared the cost-effectiveness of CBDE versus ERCP combined with laparoscopic cholecystectomy (LC) for emergency CBD stone management.
Methods:
A retrospective review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE or ERCP with LC at a single tertiary centre between 1 January 2014 and 30 September 2018. Data were collected on admission and procedural costs, length of stay, postoperative complications, and stone-related readmissions over a 5-year period.
Results:
A total of 337 patients were included, comprising 290 CBDE and 47 ERCP cases. CBDE was associated with significantly lower median total admission costs ($10 668 vs. $15 418; p < 0.001) and shorter hospital stays (median 4 vs. 7 days). Operative costs were lower for single-stage LC-CBDE compared with LC plus ERCP ($3608 vs. $4139; p = 0.009). Over 5 years, CBDE patients required fewer procedures (mean 1.19 vs. 2.06; p < 0.001) and had lower median theatre ($3696 vs. $5671; p < 0.001) and total costs ($10 856 vs. $19 418; p < 0.001).
Conclusion:
Emergency LC-CBDE is a cost-effective alternative to ERCP for CBD stone management. Although CBDE requires specialised equipment and expertise, these are offset by shorter stays, fewer procedures, and sustained long-term savings. Clinical outcomes should remain the primary determinant of management, with economic considerations providing complementary guidance.
