Laparoscopic Versus Open Surgery For Common Bile Duct Exploration
DOI:
https://doi.org/10.54112/bcsrj.v6i6.2020Keywords:
Choledocholithiasis, Laparoscopic common bile duct exploration, Open CBD exploration, Bile duct injury, minimally invasive surgeryAbstract
Choledocholithiasis remains a common surgical problem, and the choice between laparoscopic and open common bile duct (CBD) exploration continues to influence perioperative outcomes. Minimally invasive laparoscopic CBD exploration (LCBDE) offers reduced postoperative morbidity and shorter recovery times compared to open surgery, but concerns persist regarding bile duct injury (BDI) and incomplete stone clearance, particularly in resource-limited settings such as Pakistan. Objective: To compare the intraoperative and postoperative outcomes of laparoscopic versus open CBD exploration in patients with choledocholithiasis. Methods: A descriptive comparative study was conducted at the Department of General Surgery, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from November 23, 2024, to May 23, 2025. Fifty patients (aged 20–60 years, ASA ≤III) with imaging-confirmed choledocholithiasis were enrolled and divided equally into laparoscopic and open-surgery groups. Both procedures were performed by experienced consultant surgeons following standardized protocols. Intraoperative blood loss, postoperative bile drainage, hospital stay, residual stones, and CBD injuries were recorded. Data were analyzed using SPSS v26, applying Student’s t-test and Chi-square tests, with p < 0.05 considered statistically significant. Results: Baseline demographics, including age (mean 42.76 ± 9.65 vs 41.56 ± 9.27 years, p = 0.656) and BMI (26.39 ± 5.82 vs 25.92 ± 4.35 kg/m², p = 0.751), were comparable between open and laparoscopic groups. Laparoscopic exploration significantly reduced intraoperative blood loss (94.68 ± 19.95 mL vs 281.24 ± 30.73 mL; p < 0.001), postoperative bile drainage (179.25 ± 36.55 mL vs 326.92 ± 57.36 mL; p < 0.001), and hospital stay (3.96 ± 0.91 days vs 7.37 ± 1.59 days; p < 0.001). Residual stones were less frequent after laparoscopy (8% vs 32%; p = 0.034). The incidence of CBD injury was lower in the laparoscopic group (4% vs 24%; p = 0.042). Conclusion: Laparoscopic common bile duct exploration offers superior outcomes compared to open surgery, with reduced operative blood loss, fewer complications, shorter hospital stay, and higher stone-clearance rates. These findings support the broader adoption of laparoscopic techniques for choledocholithiasis management in Pakistan, emphasizing the need for enhanced laparoscopic training and resource allocation in tertiary-care settings.
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Gad E., Zakaria H., Kamel Y., Alsebaey A., Zakareya T., Abbasy M.et al.. Surgical (open and laparoscopic) management of large difficult cbd stones after different sessions of endoscopic failure: a retrospective cohort study. Annals of Medicine and Surgery 2019; 43:52-63. https://doi.org/10.1016/j.amsu.2019.05.007
Kim H., Shin S., Hwang J., & Lee J.. Outcomes of laparoscopic common bile duct exploration (lcbde) after failed endoscopic retrograde cholangiopancreatography versus primary lcbde for managing cholecystocholedocholithiasis. Journal of International Medical Research 2020;48(10). https://doi.org/10.1177/0300060520957560
Garg P. and Sharma M.. Bridging post cholecystectomy cbd transections through a novel drain loop technique – how i do it !. 2024. https://doi.org/10.21203/rs.3.rs-4466580/v1
Zhu J., Du P., He J., Tong F., Xiao W., & Li Y.. Laparoscopic common bile duct exploration for patients with a history of prior biliary surgery: a comparative study with an open approach. Australian and New Zealand Journal of Surgery 2020;91(3). https://doi.org/10.1111/ans.16529
Wan Z., Wang X., Fu N., Li Y., Xiao W., & Dong-Hui Z.. Primary closure versus t-tube drainage following laparoscopic common bile duct exploration in patients with previous biliary surgery. The American Surgeon 2020;87(1):50-55. https://doi.org/10.1177/0003134820947396
Fan Z., Pan J., & Ye-wei Z.. Recovery from a biliary stricture of a common bile duct ligature injury: a case report. World Journal of Clinical Cases 2020;8(16):3567-3572. https://doi.org/10.12998/wjcc.v8.i16.3567
Goh B., Low T., Teo J., Lee S., Chan C., Chung A.et al.. Initial single institution experience with robotic biliary surgery and bilio‐enteric anastomosis in southeast asia. Anz Journal of Surgery 2019;89(4). https://doi.org/10.1111/ans.15135
Ueda T., Tanaka T., Kirihataya Y., HARA C., & Yoshimura A.. Laparoscopic cholecystectomy and common bile duct exploration for gallstone and common bile duct stone in a patient with a left-sided gallbladder: a case report. Journal of Minimally Invasive Surgery 2023;26(4):218-221. https://doi.org/10.7602/jmis.2023.26.4.218
Ferreira C. and Noel C.. Biliary tract anatomical variance - the value of mrcp. South African Journal of Surgery 2021;59(3). https://doi.org/10.17159/2078-5151/2021/v59n3a3544
Dong H., Liu X., Luo M., Ke S., Zhan J., & Li Z.. Application of an internal drainage tube in laparoscopic common bile duct exploration. Medicine International 2021; 1(4). https://doi.org/10.3892/mi.2021.14
Özdemir T., Schmitt A., Cesaretti M., Bian A., & Jiao L... Intraoperatively malpositioned stent as a complication of common bile duct injury during laparoscopic cholecystectomy. Annals of Hepato-Biliary-Pancreatic Surgery 2019; 23(1):84. https://doi.org/10.14701/ahbps.2019.23.1.84
Nasa M., Sharma Z., Gupta M., & Puri R.. Bile duct injury—classification and prevention. Journal of Digestive Endoscopy 2020;11(03):182-186. https://doi.org/10.1055/s-0040-1709949
Hasırcı İ., BALCI E., Şahin A., Arslan K., & Şimşek G.. Evaluation of early readmissions following laparoscopic cholecystectomy. Journal of Health Sciences and Medicine 2023;6(3):613-617. https://doi.org/10.32322/jhsm.1244842
Wu X., Yan H., Zhao S., Zhang X., & Zhu K.. Clip migration complicated by choledocholithiasis after laparoscopic biliary surgery: a report of four cases. Journal of International Medical Research 2023;51(8). https://doi.org/10.1177/03000605231190766
Campaña A., Farre-Alins P., Gracia-Roman R., Campos-Serra A., Llaquet-Bayo H., Vitiello G.et al.. Indurg trial protocol: a randomized controlled trial using indocyanine green during cholecystectomy in acute cholecystitis. Digestive Surgery 2024; 41(3):141-146. https://doi.org/10.1159/000538371
Amaravadi S. and Challagundla N... A clinico-etiology and an outcome analysis of surgical management of choledocholithiasis. Cureus 2025. https://doi.org/10.7759/cureus.92099
MS A., TM N., HA N., AZ G., & SS S... Risk definition in laparoscopic versus open cholecystectomy. Archives of Surgery and Clinical Research 2019;3(1):022-026. https://doi.org/10.29328/journal.ascr.1001027
Pandey G. and Karlatif S.. A prospective study of laparoscopic cholecystectomy versus open cholecystectomy in patients with cholecystitis. Journal of Evolution of Medical and Dental Sciences 2019;8(18):1491-1493. https://doi.org/10.14260/jemds/2019/331
Pallaneeandee N., Govindan S., & Jun L... Evaluation of the common bile duct (cbd) diameter after laparoscopic cholecystectomy (lc) and laparoscopic common bile duct exploration (lcbde): a retrospective study. Surgical Laparoscopy Endoscopy & Percutaneous Techniques 2023;33(1):62-68. https://doi.org/10.1097/sle.0000000000001135
Handaya A., Werdana V., Fauzi A., Andrew J., Hanif A., Tjendra K.et al.. Gallbladder adhesion degree as predictor of conversion surgery, common bile duct injury and resurgery in laparoscopic cholecystectomy: a cross-sectional study. Annals of Medicine and Surgery 2021;68. https://doi.org/10.1016/j.amsu.2021.102631
Hajibandeh S., Hajibandeh S., Sarma D., Balakrishnan S., Eltair M., Mankotia R.et al.. Laparoscopic transcystic versus transductal common bile duct exploration: a systematic review and meta‐analysis. World Journal of Surgery 2019;43(8):1935-1948. https://doi.org/10.1007/s00268-019-05005-y
Li M., Ying T., Shen S., Song L., Suo T., Liu H.et al.. Laparoscopic common bile duct exploration in patients with previous abdominal biliary tract operations. Surgical Endoscopy 2020;34(4):1551-1560. https://doi.org/10.1007/s00464-020-07429-3
Kasai M., Cipriani F., Gayet B., Aldrighetti L., Ratti F., Sarmiento J.et al.. Laparoscopic versus open major hepatectomy: a systematic review and meta-analysis of individual patient data. Surgery 2018;163(5):985-995. https://doi.org/10.1016/j.surg.2018.01.020.
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