Common Bile Duct Pathology — Scope of Laparoscopy Illustrated Case Series Analysis

In the era of minimally invasive surgery, laparoscopic common bile duct (CBD) exploration is the best choice for addressing different difficult CBD pathologies. In the current study, we have performed laparoscopy in twelve cases (five men and seven women) with failed endoscopic retrograde cholangiopancreatography (ERCP) for CBD calculi (n = 9), a retained stent (n = 1), and CBD injuries (n = 2). The mean age of patients was 46.3 ± 8.9 years. Transcystic or transductal approach was used. In seven cases that underwent rendezvous procedure, two cases required Fogarty balloon trawl. Ureteroscopic guided stent removal was effective in one case. In the absence of choledocoscope, ureteroscope with laser lithotripsy was used in two cases of CBD calculi. Laparoscopy CBD exploration with impacted calculi extraction was effective in two cases of CBD calculi. The mean operation time was 100.3 ± 17.4 min. The pain score was 2.4 ± 0.5. The mean hospital stay was 2.7 ± 0.9 days. T-tube was not used in any of our cases. All of our cases CBD rent closed over the stent. Intraoperative or postoperative cholangiogram was not done in any of our cases. Complete CBD clearance was achieved in all of our cases. Length of stay and pain score were minimal with no postoperative complications. Even in failed ERCP cases, the first laparoscopic approach should be rendezvous procedure with the help of balloon trawl and ureteroscope which can avoid T-tube insertion and also intraoperative cholangiogram.