Laparoscopic Common Bile Duct Exploration Using Flexible Ureteroscope: Ain Shams University Experience

Introduction: Choledocholithiasis remains a common complication of gallstone disease, with endoscopicretrograde cholangiopancreatography (ERCP) being the current gold standard for management. However, ERCPhas limitations, particularly in cases involving large or impacted stones. Laparoscopic common bile duct exploration(LCBDE) using flexible choledochoscopes offers an alternative but is underutilized due to high costs. This studyevaluates the feasibility, safety, and short-term outcomes of LCBDE using flexible ureteroscopes as a cost-effectivealternative.Patients and methods: This prospective observational study included 15 patients with choledocholithiasis whohad previously failed ERCP and underwent LCBDE assisted by a flexible ureteroscope at Ain Shams UniversityHospital between October 2023 and September 2024. Procedures were performed using standardized laparoscopictechniques, with stone retrieval achieved by using flexible ureteroscope. Technical success was defined as completestone clearance with primary closure of the CBD.Results: The mean age of the cohort was 52.1±9.7 years, with males representing 60% of the patients. Themean operative time was 163.3±29.2 minutes, and the mean hospital stay was 5.1±1.0 days. Blood loss averaged168.7±85.4 mL. Technical success was achieved in 14 out of 15 patients (93.3%), with one case requiringconversion to open surgery due to stone impaction. Complications occurred in 13.3% of patients, including oneinstance of biliary leakage managed conservatively and one missed stone detected during follow-up, which wasresolved via ERCP.Conclusion: Flexible ureteroscopy-assisted LCBDE is a feasible, safe, and effective option for managingcholedocholithiasis, particularly in resource-constrained settings. While further studies with larger cohorts andlonger follow-up periods are needed to evaluate long-term outcomes, this technique holds promise for addressinggaps in hepatobiliary care access.