Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography as the first line treatment for choledocholithiasis

Background: Choledocholithiasis, or common bile duct (CBD) stones, often occurs in patients undergoing cholecystectomy. Management typically involves either laparoscopic CBD exploration (LCBDE) with cholecys-tectomy or a two-stage approach using endoscopic retrograde cholangiopancreatography (ERCP) followed by surgery. Although ERCP is widely used, its complication risks have led to increased interest in LCBDE. The objective is to compare the efficacy and outcomes of LCBDE versus ERCP in the treatment of choledocholithiasis. Methods: A prospective study of 40 patients with confirmed choledocholithiasis at KR Hospital, Mysuru, was conducted over 24 months. Patients were evenly divided between LCBDE and ERCP groups. Results: Both methods were effective in CBD stone clearance. ERCP was associated with faster recovery, earlier oral intake, and return to work. LCBDE was preferred for larger stones and wider ducts. Although a bile leak occurred only in the LCBDE group and ERCP had a 15% re-exploration rate, these differences were not statistically significant. ERCP had a 7.5% failure rate requiring surgical intervention. Notably, despite longer operative time, LCBDE resulted in significantly shorter total hospital stays due to its single-stage nature. Conclusions: Both LCBDE and ERCP are safe and effective for choledocholithiasis. ERCP offers faster recovery and is better suited for smaller, uncomplicated stones. LCBDE provides a more definitive solution for complex cases with larger stones, leading to shorter hospital stays. Treatment choice should be tailored based on stone characteristics, patient condition, and available expertise.