Laparoscopic Common Bile Duct Exploration to Treat Choledocholithiasis in Failed ERCP: a Technical Review

Secondary bile duct stones are present in as many as 15% of patients with gallstones. They are associated with severe complications, such as pancreatitis and cholangitis. After the introduction of laparoscopic cholecystectomy, endoscopic retrograde cholangiopancreatography (ERCP) replaced open surgery as the gold standard for the treatment of common bile duct stones. The benefits of the preoperative endoscopic treatment (ERCP) followed by LC (2-step approach) are substantially better compared with open surgery, regarding postoperative pain, hospital stay, return to work, and cosmesis. However, ERCP has some issues, such as procedure-related complications and failed ERCP with a rate as high as 10% to 25%. The limitations of endoscopic treatment are related to the complexity of doing a correct cannulation of the ampulla of Vater and stone retrieval. Patients with failed ERCP are considered high-complex cases. The failure in retrieving bile duct stones by using ERCP is an absolute indication for performing CBDE. Once the laparoscopic surgeons have gained experience with laparoscopic cholecystectomy, minimally invasive surgery moved one step forward, to LCBDE.