Safety and efficacy of laparoscopic versus open surgery in management of common bile duct stones: experience at the Sohag University Hospital, Egypt


  • Mena Z. Helmy Department of Surgery, Sohag College of Medicine, Sohag, Egypt
  • Ahmed E. Ahmed Department of Surgery, Sohag College of Medicine, Sohag, Egypt



Common bile duct stones, Laparoscopic common bile duct exploration, Opens common bile duct exploration


Background: Management of common bile duct (CBD) stones includes removal of the gallbladder and clearance of the ductal system which can be achieved through different approaches; endoscopic, laparoscopic or surgical.  Objective of this study is to assess the safety, efficacy, technical feasibility and surgical outcomes of laparoscopic common bile duct exploration (LCBDE) versus open surgery in the treatment of patients with cholidocholithiasis.

Methods: From June 2015 to December 2017, 120 patients with CBD stones were prospectively treated at Sohag University Hospital, Upper Egypt. Patients were divided into two groups: the first one treated by LCBDE (60 patients), while the other group treated by open surgery (60 patients).

Results: The ages of our patients were ranged from 20 to 80 (mean = 40) years, with a female predominance (female/male = 74/46). Patients in the first group were treated by laparoscopic approaches: transcystic approaches in four patients and transcholedochotomy approaches in 56 patients. Choledochoscop was routinely used to detect, extract the stones, in addition to assessment of CBD clearance. The conversion rate was done in two cases. The operative time was 120 (90-220) min, the clearance of CBD stones was achieved in 98.4% of cases (one case of missed stones). Hospital stay was 3 (2-4) days, with no mortality, morbidity rate was 5% including bile leak, and missed stone. The operative time in the second group was 100 (80-180) min, the clearance of CBD stones was achieved in 96.6% of cases (two cases of missed stones). Hospital stay was 8 (5-12) days, with no mortality; the morbidity rate was 15% in the form of wound infection, bile leak, missed stone and ileus.

Conclusions: Management of cholidocholithiasis by laparoscopic approach is feasible, effective and safe procedure with good outcome and high success rate.



Sharma A, Dahiya P, Khullar R, et al. Management of common bile duct stones in the laparoscopic era. Indian J Surg. 2012;74(3):264-9.

Shojaiefard A, Esmaeilzadeh M, Ghafouri A, et al. Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract. 2009;2009:840208.

Williams EJ, Green J, Beckingham I, Martin D, Lombard M. British Society of Gastroenterology Guidelines for the management of common bile duct stones (CBDS). Gut. 2008;57:1004-21.

Tranter SE, Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg. 2002;89:1495-504.

Poulose BK, Holzman PA. National analysis of in-hospital resources utilization in choledocholithiasis management using propensity scores. Surg Endosc. 2006;20:186-90.

Grubnik VV, Tkachenko AI, Ilyashenko VV, Vorotyntseva KO. Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc. 2012;26:2165-71.

Lee A, Min SK, Park JJ. Laparoscopic common bile duct exploration for elderly patients: as a first treatment strategy for common bile duct stones. J Korean Surg Soc. 2011;81:128-33.

Rajendra D, Bahaman N, Shokouhi. Common bile duct stones in their presentation, diagnosis and management. Indian J Surg. 2009;71:229-37.

Petelin JB. Laparoscopic management of common bile duct stones, prevention and management of laparoscopic surgical complication, 3rd edition. 2012. Available at

Wang P, Li ZS, Liu F, Ren X, Lu NH, Fan ZN. Risk factors for ERCP-related complications: a prospective multicenter study. Am J Gastroenterol. 2009;104:31- 40.

Schreurs WH, Juttmann JR, Stuifbergen WN, Oostvogel HJ. Management of common bile duct stones: selective endoscopic retrograde cholangiography and endoscopic sphincterotomy: short- and long-term results. Surg Endosc. 2002;16:1068-72.

Nicholas MS, Firas HA. Complications of endoscopic retrograde cholangiopancreatography: how to avoid and manage them. Gastroenterol Hepatol (N Y). 2013;9(8):496-504.

Kharbutli B, Velanovich V. Management of preoperatively suspected choledocholithiasis: a decision analysis. J Gastrointestinal Surg. 2008;(12):1973-80.

Poulose BK, Arbogast PG, Holzman MD. National analysis of in hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc. 2006;20(2):186-90.

Salama AF, Helmy AH, Hedaya MS, Rizk H, Esmat E. Laparoscopic common bile duct exploration for choledocholithiasis: Theodor Bilharz Research Institute preliminary experience. Egypt J Surg. 2016;35:54-8.

El Nakeeb A, Ezaat H, Abdallah T. Management and outcome of borderline common bile duct with stone: a prospective randomized study. HPB. 2016;18:385-601.

Kim EY, Lee SH, Lee JS, Hong TH. Laparoscopic CBD exploration using a V-shaped choledochotomy. BMC Surg. 2015;15:62.

Taylor CJ, Kong J, Ghussn M. Laparoscopic bile duct exploration: result of 160 consecutive cases with 2 years follow up. Aust NZ J Surg. 2007;77:440-5.

Tinoco R, Tinoco A, El-Kadre L, Peres L, Sueth D. Laparoscopic common bile duct exploration. Ann Surg. 2008;247:674-9.

Rojas OS, Arizpe BD, Marín ER, Cesin SR, Roman GR, Gómez C. Transcystic common bile duct exploration in the management of patients with choledocholithiasis. J Gastrointestinal Surg. 2003;7(4):492-6.

Lee HM, Min SK, Lee HK. Long term results of laparoscopic common bile duct exploration by choledochotomy for choledochlithiasis: 10-year experience from single center. Ann Surg Treatment Res. 2014;86(1):1-6.

Khaled YS, Deep JM, Ciaran de Souza, Amun K, Ammori BJ. Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis. Surg Endosc. 2013;27:4164-70.

Eidy M, Jesmi F, Raygan F, Pishgahroudsari M, Pazouki A. Evaluating the effect of drain site on abdominal pain after laparoscopic gastric bypass surgery for morbid obesity: a randomized controlled trial. Bariatr Surg Pract Patient Care. 2015;10:38-41.

Rafailidis S, Ballas K, Symeonidis N, Pavlidis T, Psarras K, Marakis G, et al. Primary closure of common bile duct: long-term results. Internet J Surg. 2009;(23):2.

Zhang HW, Chen YJ, Wu CH, Li WD. Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis: a retrospective analysis and comparison with conventional T-tube drainage. Am Surg. 2014;80:178-81.

Hua J, Lin S, Qian D, He Z, Zhang T, Song Z. Primary closure and rate of bile leak following laparoscopic common bile duct exploration via choledochotomy. Dig Surg. 2015; 32:1-8.

Ambreen M, Shaikh AR, Jamal A, Qureshi JN, Dalwani AG, Memon MM. Primary closure versus T-tube drainage after open choledochotomy. Asian J Surg. 2009;32:21-5.

Pérez G, Escalona A, Jarufe N, Ibáñez L, Viviani P, García C, et al. Prospective randomized study of T-tube versus biliary stent for common bile duct decompression after open choledochotomy. World J Surg. 2005;29:869-72.

Kadam R, Saxena D, Rana AS, Chabra S, Ahmed Z, Vij V, et al. Laparoscopic common bile duct exploration versus ERCP/stenting and cholecystectomy: Is a single staged procedure better? Int J Hepatobiliary Pancreat Dis. 2016;6:57-63.

Li MKW, Tang CN, Lai ECH. Managing concomitant gallbladder stones and common bile duct stones in the laparoscopic era: a systematic review. Asian J Endosc Surg. 2011;4:53-8.

Halawani HM, Tamim H, Khalifeh F, Mailhac A, Taher A, Hoballah J, et al. Outcomes of laparoscopic vs open common bile duct exploration: analysis of the NSQIP database. J Am Coll Surg. 2017;224(5):833-40.

Jennifer EV, Desmond HB. Common bile duct exploration for choledocholithiasis. Surg Clin N Am. 2008(88):1315-28.






Original Research Articles