Laparoscopic common bile duct exploration for choledocholithiasis on an emergency setting

Choledocholithiasis is a common clinical condition that may present with severe complications such as acute cholecystitis or cholangitis, requiring treatment on an emergency setting. This situation is frequently managed following an endoscopic approach by ERCP. However, access to emergent endoscopic biliary decompression is lacking in most centers. In addition, experience in laparoscopic common bile duct exploration (LCBDE) in elective patients is increasing revealing good outcomes. This study analyzes the outcomes of LCBDE management of choledocholithiasis performed on an emergency setting (ELCBDE).

We performed a descriptive, prospective, single-center study of patients undergoing ELCBDE from January 2020 to December 2023. Demographic, clinical, and surgical variables were recorded. Postoperative complications (Dindo-Clavien), the success of stone clearance, and the occurrence of bile leaks (ISGLS) were also documented. Recurrence of choledocholithiasis and the association between severe complications and Charlson Comorbidity Index (CCI) were analyzed.

A total of 31 patients were included. Median age was of 78 years. The transductal (TD) approach was employed in all cases without conversion to open surgery. The median CCI was 4. Intraoperative cholangiography was performed in 19.4% of cases and over 4 stones were extracted in 35.5% of the patients. Primary closure of the choledochotomy was achieved in 93.5% of patients. Severe complications (DindoClavien ≥ 3) occurred in 6.5% of patients. There were no reintervention or technique related deaths. Stone recurrence was not detected. The mean hospital stay was 4 days. Neither CCI nor advanced age was significantly associated with severe complications development (p > 0.05).

ELCBDE plus LC is an effective and safe procedure associated with low morbidity and mortality rates. Patients with a high CCI or advanced age should not be discarded for emergent laparoscopic approach. Our results support the choice of ELCBDE as a primary option in the emergency management of choledocholithiasis.