Management of multiple common bile duct stones via laparoscopic transcholedochal exploration: an observational study

Objective The study is an attempt to assess the feasibility of laparoscopic common bile duct exploration (LCBDE) in patients with multiple common bile duct (CBD) stones. Methods A prospective observational study was conducted over 1 year (2017–2018). Patients with gallbladder in situ , bile duct stones (1), and a dilated duct (7 mm) were included. CBS stones and duct size were confirmed by ultrasound, computed tomography, and/or magnetic resonance cholangiopancreatography. Laparoscopic cholecystectomy and bile duct exploration (transcholedochal) were performed using a four-port technique. Patients were evaluated through regular follow-up for 6 months and required information was collected. The primary outcome was stone clearance rate. The secondary outcomes were operative time, postoperative complications, open conversion, and length of hospital stay. Results A total of 31 patients were enrolled. The mean age was 44.03 ± 13.91 years with a male-to-female ratio of 2.87:1. The mean number of CBD stones was 4.62 ± 1.91. LCBDE was technically successful in 27 patients (87.09%), while 4 (12.9%) required open conversion. The failure rate of on-table choledochoscopy for complete stone clearance was 6.4%. The mean operative time in the successful laparoscopic group was 110.96 ± 20.15 min. No intraoperative complications were encountered. A T-tube was placed in 23 patients (74.19%), while 7 (22.58%) underwent primary closure of the CBD. One patient required Roux-en-Y hepaticojejunostomy for concomitant hepatolithiasis. Five patients (16.1%) developed postoperative complications (4 minor and 1 major). The mean length of hospital stay was 4.09 ± 1.10 days. On follow-up, there was no evidence of retained/residual stone. There was no postoperative (30 and 90 days) mortality. The stone clearance rate was 100%. Conclusion The study showed that transcholedochal LCBDE is a safe procedure in terms of stone clearance rates, with acceptable perioperative complications and conversion rates for multiple CBD stones.