Outcomes of Laparoscopic Common Bile Duct Exploration After Failed Endoscopic Retrograde Cholangiopancreatography in Patients with Concomitant Gall Stones and Common Bile Duct Stones: A Prospective Study.
BACKGROUND
The aim of the present study was to compare the outcomes of secondary laparoscopic CBD exploration (LCBDE) following failed endoscopic retrograde cholangiopancreatography (ERCP) and primary laparoscopic common bile duct (CBD) exploration.


METHODS
One hundred eighty-five patients undergoing LCBDE were divided into Group I consisting of patients undergoing a primary LCBDE (n = 102) and Group II consisting of patients undergoing LCBDE after failure of ERCP to clear the CBD stones (n = 83). Primary outcome measure was successful laparoscopic CBD clearance. The secondary outcome measures were degree of difficulty, operative time, complications, hospital stay, and the cost of treatment.


RESULTS
Success rate was similar in both groups (85.3% versus 80.7%). Mean operative time, degree of difficulty, hospital stay, and cost of procedure were significantly higher in Group II (P value <.05).


CONCLUSIONS
It may be prudent to consider ERCP failure patients for primary LCBDE than risk the complications of ERCP if they are suitable for primary surgery.
1 Department of Surgical Disciplines, All India Institute of Medical Sciences , New Delhi, India .
Virinder Kumar
VK
Bansal
1 Department of Surgical Disciplines, All India Institute of Medical Sciences , New Delhi, India .
Asuri
A
Krishna
1 Department of Surgical Disciplines, All India Institute of Medical Sciences , New Delhi, India .
Karthik
K
Rajan
1 Department of Surgical Disciplines, All India Institute of Medical Sciences , New Delhi, India .
Omprakash
O
Prajapati
1 Department of Surgical Disciplines, All India Institute of Medical Sciences , New Delhi, India .
Subodh
S
Kumar
2 Department of Anaesthesiology, All India Institute of Medical Sciences , New Delhi, India .
Subramaniam
S
Rajeshwari
3 Department of Gastroenterology, All India Institute of Medical Sciences , New Delhi, India .
Pramod
P
Garg
1 Department of Surgical Disciplines, All India Institute of Medical Sciences , New Delhi, India .
Mahesh C
MC
Misra
D000293:Adolescent; D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000191:economics / Q000379:methods; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D003365:Costs and Cost Analysis; D005260:Female; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
CBD stones; ERCP failure; laparoscopic CBD exploration