Application of laparoscopic cholecystectomy, common bile duct exploration, endoscopic lithotripsy of bile duct stones, and antegrade biliary stenting

Abstract

Introduction: Primary closure of choledochotomy (PCC) following common bile duct (CBD) exploration is increasingly accepted. However, this technique is associated with complications, primarily bile leaks, especially when retained CBD stones are present. To mitigate these risks and enhance outcomes, we propose a comprehensive procedural approach that includes laparoscopic cholecystectomy (LC), CBD exploration, endoscopic lithotripsy of bile duct stones, and antegrade biliary stenting.

Patients and Methods: From January 2020 to December 2022, a total of 15 patients with cholelithiasis and associated common bile duct stones (CL-CBDS) underwent LC, CBD exploration with endoscopic lithotripsy of bile duct stones, and antegrade biliary stenting at the General Surgery Department of E Hospital.

Results: The average age of the patients was 64.9 ± 12.1 years, with a male-to-female ratio of 8:7. Previous upper abdominal surgery accounted for 13.3% of the cases. The average surgical time in our study was 195.9 minutes, and the mean postoperative hospital stay was 7 days. There were no intraoperative or postoperative complications. The stone clearance rate was 100%. The median follow-up period was one month, with no evidence of residual stones, bile duct stricture, or bile leakage in any of the patients.

Conclusion: LC, CBD exploration with endoscopic lithotripsy of bile duct stones, and antegrade biliary stenting is an effective and safe technique for managing CL-CBDS. This approach avoids complications associated with managing and removing T-tube drainage, provides CBD decompression, and reduces the length of hospital stay.

Keywords: Laparoscopic cholecystectomy, common bile duct exploration, biliary stenting.

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