Laparoscopic common bile duct exploration: 15-year experience in a district general hospital

Introduction The treatment of common bile duct (CBD) stones remains controversial with debate between endoscopic cholangiopancreatography (ERCP) and CBD exploration. A recent meta-analysis has shown no significant difference between these approaches; however, there is a trend in the literature to favour a single-stage procedure in the form of laparoscopic CBD exploration. We report our experience over a 15-year period. Methods All cases of CBD exploration were identified from 2000 to 2015 and analysed retrospectively from a large NHS Foundation Trust in Northumbria. There were no exclusions. The mean clinical follow-up was 6 months (range 3-36 months). Results A total of 296 patients were included who underwent laparoscopic CBD exploration: 203 were female and 93 were male. The mean age was 60 years (range 16-84 years). A total of 231 procedures were performed electively and 65 as an emergency. Ten procedures were successfully performed as day cases. Eleven procedures were converted to an open procedure due to adhesions or a difficult dissection (4 %). Sixty-three procedures were performed with a transcystic approach with a mean post-op stay of 2 days (range 0-7). A total of 233 procedures were performed with a choledocotomy with a mean post-op stay of 6 days (range 3-14 days). Stone clearance was successful in 255 patients (86 %). Three patients died over the study period. Two were for medical complications and one for abdominal sepsis. Three patients returned to theatre for early post-operative bleeding (1 %). Sixteen patients had persistent bile leaks following a choledocotomy (6.8 %). No patients had a bile leak following transcystic exploration. Fourteen patients were followed up following failed stone removal. Nine had a successful ERCP, three had no stone seen on MRCP, and one patient required re-operation following a failed ERCP. Conclusions Laparoscopic bile duct exploration can be performed successfully in both the emergency and elective settings. Day-case surgery is feasible in selected patients. A transcystic approach should be favoured where possible.