Evaluation of laparoscopic common bile duct exploration versus intraoperative endoscopic retrograde cholangiopancreatography in the management of choledocholithiasis

Objective
To evaluate laparoscopic cholecystectomy plus laparoscopic exploration of common bile duct (CBD) versus laparoscopic cholecystectomy plus intraoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis.
Background
With advancement in technique and increased experience in the field of minimal access surgery, single-stage approaches may shorten the length of hospital stay.
Patients and methods
This study included 120 patients with gallbladder and CBD stones. All patients were operated upon by laparoscopic cholecystectomy, and then CBD stones were treated in 60 patients with intraoperative ERCP (group A), whereas the other 60 patients were treated with laparoscopic CBD exploration (Group B). Follow-up period was 6 months.
Results
No mortality was seen. Operative time was significantly higher in group B (2.98 h) (<0.001). However, no significant differences were found regarding conversion (=0.2). Hemorrhage and collection was significantly less in group A (<0.001). There was no pancreatic duct injury in group B (=0.006). There was no significant difference between both groups regarding penetration (=0.07) and recurrence of stone (=0.2), but CBD stricture was high in group B (=0.005).
Conclusion
Both procedures can be used efficiently for treating CBD stones. However, intraoperative ERCP is a more preferable option to a greater extent when facilities for this intervention are available, owing to being less invasive, less operative time, less blood loss, less hospital stay, no collection, and less postoperative CBD stricture.