Same-session versus scheduled laparoscopic exploration of common bile duct after failure of extraction of common bile duct stones by endoscopic retrograde cholangiopancreatography

Aim
To compare between same-session and scheduled laparoscopic exploration of common bile duct (LECBD) after failure of extraction of CBD stones by endoscopic retrograde cholangiopancreatography (ERCP) regarding feasibility, operative time, conversion to open surgery, length of hospital stay, and complications.
Patients and methods
It is a comparative randomized prospective study that was done at Menoufia University Hospital from January 2018 to February 2021. Among all patients scheduled for CBD stone(s) extraction by ERCP, we selected 40 patients of failed stone extraction by ERCP to be enrolled in this study. We divided them randomly into two groups, LECBD will be done for the patients either in the same session (group A) or scheduled 1 week later (group B).
Results
LECBD was successful in 18 out of 20 patients who underwent CBD exploration at the same session. On the other hand, LECBD was successful in 19 patients out of 20 who underwent CBD exploration after 1 week with insignificant value of 0.1. Three cases were converted to open CBD exploration (two in the same session and one in the scheduled group). Mean duration of ERCP was 29.5±5.9 min in the same-session group, while it was 33.3±8.2 in the scheduled group with no significant difference between two groups (=0.12). Mean duration of laparoscopic CBD exploration in the same-session group was significantly higher (89.2±8.8 min) than scheduled session (79.5±5.9 min) (=0.001). No significant difference on the rate of complications regarding minor bile leak, postoperative chest infection, postoperative wound infections, and missed stone occurred between two groups (=0.4). Cholangitis and mild pancreatitis (15 and 20%, respectively) were significantly higher in the scheduled group than the same-session group (0 and 10%, respectively) with value of 0.01 and .02, respectively. Total hospital stay was lower in patients who underwent the same-session CBD exploration (3.4±1.1 days) rather than scheduled-session CBD exploration (5±1.7 days) with significant value of 0.001. The total cost for patients in the scheduled-session group (6450±591) Egyptian pounds was significantly higher than the same-session group (5450±1169) with a highly significant value of 0.001.
Conclusion
Same-session LECBD after failure of ERCP for management of CBD stones is feasible. It shows lower cost, shorter hospital stay, and lower rate of complications than scheduled LECBD, in spite of a higher rate of conversion to open surgery and longer operative time in same-session group.