Treatment of common bile duct stones following failed endoscopic retrograde cholangiopancreatography

BACKGROUND: Choledocholithiasis is a frequently encountered pathology. Mostly utilized methods for treating elective common bile duct stones (CBDS) are endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic and open common bile duct exploration (LCBDE and OCBDE, respectively). Our aim was to compare LCBDE and OCBDE following failed ERCP, in aspect of safety and efficacy among non-septic patients with CBD stones aged 18 years or older. METHODS: Case files of patients with CBDS who underwent ERCP and underwent operation following failed ERCP between 2007 and 2014 were retrospectively examined. Infra- and postoperative findings, surgical techniques, operating time, complications, duct clearance, stone recurrence, length of hospital stay and morbidity rates were determined. RESULTS: There were 42 patients. 25 females and 17 males. Most common ERCP failure reason was extirpation failure. Five patients had intrahepatic stones. Mean operating time was 132.3 +/- 43.8 minutes. Postoperative complication rate was 9.5%. Three patients underwent postoperative ERCP. Mean duration of stay was 7.45 +/- 4.94 days. Clearance rates were 84.2% and 95.5% for laparoscopic and open treatment groups, respectively. Morbidity rate was 14.3%. Between treatment groups, no statistically significant difference was noted for CBD diameters, stone counts, largest stone diameters, intrahepatic bile duct stone rates, operating times, postoperative complications or ERCP need, residual stones, durations of stay, clearance, and morbidity. No stone recurrences or perioperative mortalities were noted. CONCLUSIONS: LCBDE offers a minimally invasive, safe and reliable method of treatment of CBD stones following failed ERCP. Routine choledochoscopy ensures bile duct clearance and eliminates the need for T-tube usage.