Choledochoscopy as a diagnostic and therapeutic tool for common bile duct stones

Aim-Background The aim is to present the results of a retrospective study comparing a) choledochoscopy in open and laparoscopic Common Bile Duct Exploration (CBDE) regarding the clearance of Common Bile Duct (CBD) from stones, b) open CBDE with and without choledochoscopy, and c) transcystic vs. transductal laparoscopic choledochoscopy. Patients-Methods Data were extracted from the medical records of 251 patients who had undergone open or laparoscopic Common Bile Duct Exploration. We excluded all those undergoing successful ERCP and sphincterotomy. The patients were separated into the following groups Group A: 127 patients who underwent Open CBDE; subgroup A1 comprised 52 patients who underwent Open CBDE with flexible choledochoscopy and intraoperative cholangiography (open CBDE+FCS+IOC), and Subgroup A2 included 75 patients who underwent Open CBDE with cholangiography (open CBDE+IOC). Group B: 124 patients who underwent Laparoscopic CBDE; subgroup B1 included 15 patients undergoing transcystic choledochoscopy, and subgroup B2 comprised 109 patients who underwent transductal choledochoscopy. Results The stone clearance rate in group A1 (open CBDE +FCS+IOC) was 98%, and in group A2 (open CBDE +IOC) it was 93%. However, the difference in the success rate between the choledochoscopic and “blind” technique was of no statistical significance (p=0.235). Similarly, no statistical significance was found between the success rates of open (98%) vs. laparoscopic (94%) choledochoscopy (p=0.869), or transcystic (Group B1) vs. transductal (GroupB2) laparoscopic choledochoscopy (87% vs. 95% respectively) (p=0.207), although greater success was noted in favour of transductal choledochoscopy. The conversion rate of transductal laparoscopic CBDE was 8%, and the main reason for conversion was stone impaction. Conclusion No statistical difference is noted in stone clearance rate between flexible choledochoscopy (FCS) and intraoperative cholangiography. However, intraoperative cholangiography has better outcomes regarding stone clearance when it is assisted by choledochoscopy. A search of the literature found no available data comparing the success rate of open vs. laparoscopic choledochoscopy. Our study demonstrated that the difference in the stone clearance rate between the two approaches was not statistically significant. Laparoscopic transcystic CBDE is less invasive and is associated with a lower complication rate, but it has higher failure rates compared to the transduct