Background : When endoscopic approach for extraction of common bile duct (CBD) stones fails, surgical CBD exploration is needed. The aim of this study is to compare outcomes of laparoscopic common bile duct exploration (LCBDE) after failed endoscopic retrograde cholangiopancreatography(ERCP) versus primary LCBDE for managing cholecysto-choledocholithiasis.

Methods : We analyzed 59 patients underwent LCBDE during laparoscopic cholecystectomy (LC) for managing choleocysto-choledocholithiasis in period from 2013 to 2019 retrospectively. We divided in two groups : primary LCBDE plus LC (group I) and LCBDE plus LC after failed ERCP(group II). The demographics, the reason for ERCP failed, peri-operative details, and postoperative outcomes were evaluated.

Results : 31 patients (group II) failed CBD stone removal by pre-operative ERCP because of remaining stones after ERCP(n=9), failed cannulation (n=6), failed sedation(n=6), peri-ampullary diverticulum(n=5), previous billoth II gastrectomy(n=3), huge stone(n=1) and impacted stone(n=1). Mean CBD stone size and CBD diameter was not differ between two groups(9.1mm versus 9.3mm, p=0.943, 14.8mm versus 13.0mm, p=0.932). ERCP degree of difficulty grading scale was also not differ between two groups(p=0.646). In both groups, CBD clearance rate above 96%(96.4% versus 100%, p=0.272). The mean operative time and mean duration of hospital stay did not significantly differ between the two groups(92.0 min versus 84.4 min, p=0.399, 7.4 day versus 7.0 day, p=0.591). There are also no difference in overall complication rate and open conversion rate(3.6% versus 3.2%, p=0.942, 8.0% versus 0%, p=0.115).

Conclusions : When it is predicted to be difficult or failed to extract CBD stones by ERCP, primary LCBDE is an acceptable alternative treatment for managing cholecysto-choledocholithiasis.