Combined Laparoscopic Cholecystectomy and Transcystic Common Bile Duct Exploration for Choledocholithiasis

Abstract Background: There is no consensus on the ideal approach for managing patients with common bile duct (CBD) stones. The combined approach is less popular, possibly due to the complexity of the surgical technique and the availability of choledochoscope. Aim: We aim to assess the safety and feasibility of transcystic (TC) CBD exploration using the flexible bronchoscope for choledocholithiasis. Methods: Forty patients with symptomatic calculus gallbladder with concomitant CBD stones were randomized into two groups. Single-session laparoscopic cholecystectomy (LC) and laparoscopic TC CBD exploration were performed for one group using the flexible bronchoscope. Endoscopic retrograde cholangiopancreatography followed by LC after 4–6 weeks was conducted for the other group. Results: Twenty patients were randomized to each group. The clearance rate of CBD stones was significantly higher in the single-session Group A (95%) than in the two-session Group B (70%). Group B was associated with a significantly prolonged operative ( P = 0.01). The total hospital stay and operative time were significantly longer in Group B than in Group A ( P = 0.004). There was no significant difference between both groups regarding the intraoperative or postoperative complications. Conclusion: Combined LC and TC CBD exploration is a safe and feasible approach and is associated with significantly shorter operative time and length of hospital stay.