Evaluation of the Effectiveness of Endoscopic, Laparoscopic, and Surgical Treatments in Common Bile Duct Stones

Abstract

Abstract

Background: Choledocholithiasis, commonly known as common bile duct stones (CBD), can lead to disorders such as obstructive jaundice, cholangitis, and acute biliary pancreatitis, and requires endoscopic or surgical intervention, whether laparoscopic or open, for the effective removal of stones from the CBD. Timely treatment is essential to prevent complications and improve patient outcomes, making it critical to employ appropriate diagnostic tools and therapeutic strategies in managing this condition. The aim of this study is to report on our experience in the management of choledocholithiasis by evaluating the effectiveness of various diagnostic and therapeutic approaches employed at our center.

Methods: This study is a retrospective analysis of prospectively collected data from all patients treated with diagnoses with choledocholithiasis at the Department of General Surgery, Clinic III, at the University Hospital Center "Mother Teresa" from January 1, 2024 to December 31, 2024, the investigation encompasses a comprehensive cohort of 448 patients who underwent a total of 535 interventional procedures for biliary stone disease.

Results: There were 448 patients diagnosed with choledocholithiasis, who underwent a total of 535 interventional procedures. Endoscopic retrograde cholangiopancreatography (ERCP) was the primary method, utilized in 509 instances (95.1%). Among these, 61 patients had papillotomy alone, while 243 cases involved papillotomy combined with stone extraction. Biliary lavage was performed in 15 patients, and stent placement was necessary for 84. Despite a high success rate, 67 ERCP procedures were unsuccessful, resulting in a failure rate of approximately 13%. This necessitated further ERCP attempts or surgical treatment. The laparoscopic cohort included eight procedures, primarily choledochotomies, with five patients having had prior unsuccessful ERCP. Open surgical interventions occurred in 18 patients, representing only 3% of total cases, highlighting the effectiveness of minimally invasive techniques in managing choledocholithiasis.

Conclusion: Effective management of choledocholithiasis requires patient centered, multidisciplinary approach, with treatment strategies tailored to the patient's clinical status, available resources, and institutional expertise.

Keywords: Choledocholithiasis, ERCP, laparoscopic intervention, open surgical intervention