title: Laparoscopic exploration can salvage failed endoscopic bile duct stone extraction.
abstract: BACKGROUND
  Conventionally, patients who failed endoscopic removal of common bile duct stones (CBDS) by endoscopic retrograde cholangiopancreaticography (ERCP) would be treated with open cholecystectomy and common bile duct exploration. Laparoscopic common bile duct exploration (LCBDE) is an established option for treating CBDS. The aim of this paper was to look at the feasibility of LCBDE as a salvage procedure after failed endoscopic stone extraction (ESE). The secondary endpoint was to examine the short-term outcomes of our LCBDE series.
  
  
  METHODS
  We retrospectively reviewed a prospective database to study the feasibility of LCBDE as a salvage procedure for failed ERCP.
  
  
  RESULTS
  Since its inception in 2006, 43 patients had undergone LCBDE at our centre. This was achieved via a transcystic approach in 25 patients and laparoscopic choledochotomy in 15 patients. There were three conversions. Of these 43 patients, 21 had a pre-operative attempt at ESE, but only six patients had their ducts cleared endoscopically. The 15 patients who failed ESE underwent LCBDE, of which 14 achieved successful stone clearance and one required open conversion. One patient developed a bile leak, which resolved spontaneously. The median length of stay (LOS) for these 15 patients was three days, while the median LOS for the whole cohort was two days.
  
  
  CONCLUSIONS
  LCBDE has been shown to be a safe and effective method for treating CBDS, with the added bonus of a short hospital stay. Where the expertise is available, LCBDE is a safe option as a salvage procedure for failed ESE.
authors.affiliation: Centre for Advanced Laparoscopic Surgery, Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore. vishalkumar.shelat@nathealthgroup.com
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Shelat
authors.forename: Chung Yip
authors.initials: CY
authors.lastname: Chan
authors.forename: Kui Hin
authors.initials: KH
authors.lastname: Liau
authors.forename: Choon Kiat
authors.initials: CK
authors.lastname: Ho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D016879:Salvage Therapy; D017211:Treatment Failure