Laparoscopic management after failed endoscopic stone removal in nondilated common bile duct

• Endoscopic CBD stone removal is still occasionally unsuccessful.
• Nondilated CBD is a contraindication to choledochotomy.
• Studies of LCBDE after failed endoscopic procedures in nondilated CBD are rare.
• LCBDE as a salvage procedure is safe and feasible for failed endoscopic stone removal in nondilated CBD.

IntroductionWhen common bile duct (CBD) stone removal by endoscopic procedure fails, CBD exploration is an alternative procedure. However, nondilated CBD is a contraindication to choledochotomy. The purpose of this study was to investigate the results of laparoscopic CBD exploration (LCBDE) following unsuccessful endoscopic stone removal in nondilated CBD.MethodsFrom January 2011 to June 2015, we retrospectively analyzed 165 LCBDEs. Group 1 was defined as patients with nondilated CBD who underwent LCBDE after failed endoscopic stone removal. Group 2 included patients with dilated CBD who received LCBDE. Outcomes of LCBDE were compared between the two groups.ResultsThere were 23 patients in Group 1 and 142 in Group 2. No significant differences were observed in demographics other than CBD diameter. There was no significant difference in operating time, postoperative hospital stay, open conversion rate, overall postoperative complication rate, retained stone rate, and recurrence rate between the two groups.ConclusionLCBDE in experienced hands is a safe and feasible option after failure of endoscopic stone removal in nondilated CBD. However, larger numbers of cases and longer follow-up are required to validate LCBDE in nondilated CBD.