Introduction : 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 choledocholithiasis.

Methods : We analyzed 59 patients underwent LCBDE during LC for managing choledocholithiasis in period from 2013 to 2018 retrospectively. We divided in two groups : primary laparoscopic CBD exploration(group I) and laparoscopic CBD exploration after failed ERCP(group II). The demographics, the reason for ERCP failed, intra-operative details, and postoperative outcomes were evaluated.

Results : 31 patients(group II) underwent and failed pre-operative endoscopic retrograde cholangiopancreatography (ERCP) because of remaining stones after ERCP(9 patients), failed cannulation (6 patients), patient’s irritability(6 patients), peri-ampullary diverticulum(5 patients), previous billoth gastrectomy( 3 patients), huge stone(1 patients) and impacted stone(1 patients). Mean CBD stone size and CBD diameter was not differ between two groups. In both groups CBD clearance rate above 96%. The mean operative time and mean duration of post-operative stay did not significantly differ between the two groups. There are also no difference in overall complication rate and open conversion rate.

Conclusions : When ERCP is predicted to be difficult to extract CBD stones, primary LCBDE is safe and effective for managing cholecysto-choledocholithiasis.