Primary Laparoscopic Common Bile Duct Exploration in Management of Choledocholithiasis in a Resource Constraint Setting: Our Experience

Abstract:

Introduction: Today’s options for biliary bypass procedures, in symptomatic choledocholithiasis, range from open surgery to laparo-endoscopic hybrid procedures. The aim of this study was to analyse the outcomes of patients with choledocholithiasis primarily treated with laparoscopic common bile duct exploration and Laparoscopic cholecystectomy (LCBDE + LC) in a remote setting with no facility of endoscopic retrograde cholangio- pancreatography and endoscopic sphincterotomy (ERCP + ES).

Methods: We performed a retrospective cross sectional study from March 2011 to June 2021. We included all symptomatic patients with common bile duct stones who underwent surgery by a single surgeon. A primary laparoscopic bile duct exploration with intraoperative cholangioscopy with T-tube placement with cholecystectomy was offered to all patients. Data was maintained in excel sheets and analysed with respect to their demographics, case records, operation notes and follow-up data. All significant intra operative and postoperative complications were recorded and our results were analysed. Results: A total of 5793 patients underwent laparoscopic cholecystectomy from march 2011 to June 2021 by a single surgeon. 58 patients were diagnosed to have choledocholithiasis and underwent LCBDE + LC for the same. We found a female predominance (62.1%), advanced mean age (48.3 years) and multiple comorbidities. Most patients had previous episodes of cholangitis. Mean operative time 218.74 min. Only one patient required conversion into an open procedure. CBD clearance rate was 96.5%. We had a median of 18 (12–60) months of follow-up. All patients except 2 had normalisation of liver enzymes during follow-up. Four patients required a second surgery. Port site infection, retained stones, retained T tube end and leak were encountered.

Conclusions: Laparoscopic CBD exploration with intraoperative cholangioscopy with cholecystectomy seems to be safe and effective treatment for patients with difficult common bile duct stones. This procedure can be a good first line option for patients with advanced age and multiple comorbidities, avoiding the cost and morbidities of ERCP + ES.