195 Laparoscopic Common Bile Duct Exploration: A Safe and Effective First-Line Strategy for Choledocholithiasis in the General Surgical Setting

Abstract Aim To evaluate the safety, efficacy, and technical approach of laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis at a UK tertiary centre. Method A retrospective analysis from a prospectively maintained database was performed on 36 patients undergoing LCBDE between November 2024 and June 2025. The primary endpoint was successful stone clearance; secondary endpoints included complications, operative time, length of stay, and readmissions. Results Mean age was 55 years (range 21–79), with 67% female. Emergency cases constituted 69%; 72% had deranged liver function tests and 14% had a bilirubin >51 μmol/L. The most common indication was confirmed CBD stones (84%) on preoperative imaging, with 28% having gallstone pancreatitis. A transcystic approach was used in 94%, involving an ultra-slim 2.7 mm scope in 75%. Electrohydraulic lithotripsy was required in one case. Mean operative time was 110 minutes. Ductal clearance was achieved in 94% of patients. Postoperative complications included bile leak (5.6%) and retained stones (8.3%), disproportionately affecting older males. There were no cases of post-operative pancreatitis. Average post-operative stay was 2 days (range 0–9), with two readmissions and no conversions to open surgery. Conclusions LCBDE is a safe and effective single-stage approach for choledocholithiasis, with high success rates and low complication rates in this early cohort. The transcystic route, combined with an ultra-slim scope, was successful in most cases, reducing the need for more invasive transductal exploration. These results support broader adoption of LCBDE in general surgical practice, improving access and potentially reducing reliance on ERCP.