Although laparoscopic cholecystectomy (LC) has become the gold standard for the management of
gallstone disease, the application of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis
has been slower. The aim of this study is to determine the feasibility and effectiveness
of LCBDE.
A retrospective cohort study was conducted to compare LCBDE (n = 82) with conventional common
bile duct exploration (CCBDE) (n = 75) and endoscopic sphincterotomy (EST) (n = 80) in the
management of choledocholithiasis. All our LCBDEs were performed through choledochotomy with
T-tube placement. The mean operative time of the LCBDE group (124 ±48 minutes) was not significantly
longer then the CCBDE group (118 ±35 minutes), while the postoperative hospitalization
was shorter in both the LCBDE (8 ±5 days) and EST (9 ±4 days) groups than in the CCBDE
(13 ±6 days) group. In the LCBDE group, 14 patients (17.1%) required postoperative choledochoscopy
to clear residual stones through the T-tube tract. The only mortality occurred in the
CCBDE group. The morbidity rate was 3.7% (3/82) in the LCBDE group, including bile leakage in
1 case and bile peritonitis in 2 cases; 6.7% (5/75) in the CCBDE group, including atlectasis in 2
cases, sepsis in 1, and wound infection in 2. There were 2 cases of postoperative pancreatitis (2.5%;
2/80) in the EST group. The difference in the average number of sessions needed for complete clearance
of choledocholithiasis in each group was statistically significant (EST, 1.46 ±0.67; LCBDE,
1.23 ±0.42; and CCBDE, 1.09 ±0.28; P < 0.0001). Our results suggested that EST and LCBDE
tended to require more therapeutic sessions then CCBDE, although these sessions were less invasive.
The benefits of LCBDE include minimal invasiveness, concurrent treatment of gallbladder
stone and CBD stones in a single session, and a shorter postoperative hospital stay. However a longer
learning curve is needed. Selection of the most suitable therapeutic option for individual patients
by an experienced surgeon gives the most benefits to patients.
