A Prospective Comparative Study of Laparoscopic Common Bile Duct Exploration and Endoscopic Retrograde Cholangiopancreatography for Managing Common Bile Duct Calculi.

INTRODUCTION

Common bile duct (CBD) calculi are typically managed by either laparoscopic CBD exploration (LCBDE) or endoscopic retrograde cholangiopancreatography (ERCP). The superiority of one method over the other remains a matter of debate. This study was designed to compare the efficacy and morbidity profile of LCBDE and ERCP in the management of CBD calculi.

MATERIALS AND METHODS

This analytical cross-sectional study was conducted from January 2021 to July 2024. A total of 72 patients with CBD calculi were included, with 36 undergoing LCBDE and 36 undergoing preoperative ERCP followed by laparoscopic cholecystectomy. The primary endpoint was the complete stone clearance rate from the CBD via LCBDE (using either a trans-cystic or supra-duodenal approach) or at the first ERCP procedure. Morbidity and mortality outcomes were also assessed.

RESULTS

The stone clearance rate was significantly higher in the LCBDE group (88.89%) compared to the ERCP group (72.22%), with an OR of 3.077 and a 95% CI of 0.864-10.954. Retained CBD calculi were noted in 10 patients in the ERCP group, compared to four in the LCBDE group. Two patients in the ERCP group developed acute pancreatitis with elevated amylase and lipase levels. Biliary leaks were observed in two patients in the LCBDE group and one in the ERCP group who succumbed to multidrug-resistant sepsis.

CONCLUSION

LCBDE demonstrates higher efficacy in clearing CBD calculi compared to ERCP, especially in patients with multiple and large CBD calculi, with a lower morbidity profile.