Clinical Outcomes of Electrohydraulic Lithotripsy‐Assisted Laparoscopic Bile Duct Stone Removal: A Retrospective Multi‐Center Study From Vietnam

ABSTRACT Purposes Managing complex bile duct stones, particularly those involving intrahepatic branches, remains a surgical challenge. Laparoscopic common bile duct exploration (LCBDE) with intraoperative flexible cholangioscopy and electrohydraulic lithotripsy (EHL) has emerged as a potential one‐stage, minimally invasive alternative. Methods This retrospective multicenter cohort included 83 patients with choledocholithiasis or hepatolithiasis who underwent single‐stage LCBDE with intraoperative cholangioscopy and EHL. The early postoperative stone‐free rate was assessed by ultrasound performed within 48–72 h after surgery. For patients who underwent T‐tube drainage ( n = 28, 33.7%), findings from postoperative day 10–14 cholangiography were incorporated into the final analysis. Operative parameters, postoperative outcomes, and factors associated with residual stones were analyzed. Results The intraoperative stone clearance rate was 85.5%. Early imaging confirmed complete stone clearance in 75.9% of patients. Residual stones were most frequently associated with intrahepatic involvement ( p = 0.004) and biliary duct abnormalities such as stricture or angulation ( p < 0.001). The complication rate was 4.8%. Conclusions LCBDE with intraoperative cholangioscopy and electrohydraulic lithotripsy is a safe and effective single‐stage treatment for complex bile duct stones in resource‐limited settings. Broader application of this approach may reduce treatment burden and improve access to definitive biliary care.