Laparoscopic Common Bile Duct Exploration After Failed ERCP with CBD Primary Closure

Cholelithiasis with concomitant CBD stones is a common scenario faced in the clinical practice. There are various approaches for the management of this pathology. With the availability and advancement of endoscopic training, pre-operative ERCP followed by LC is considered the standard of care. ERCP has its own limitations concerning very large stones which cannot be removed endoscopically or when the ampulla cannot be cannulated due to anatomical challenges. Laparoscopic CBD exploration (LCBDE) for Common bile duct (CBD) stones with laparoscopic cholecystectomy (LC) is an alternative to open CBD exploration, in patients with failed endoscopic retrograde cholangio-pancreatography (ERCP). Primary closure of choledochotomy over stent provides biliary decompression like T-tube but requires choledochoscopy to ensure clearance of the CBD and eliminates the need for T-tube. Primary closure of CBD over stent needs follow-up endoscopy / ERCP to remove the stent (Rendezvous Technique).