Learning curve experience in laparoscopic common bile duct exploration for concomitant cholelithiasis and choledocholithiasis

Background and aims: Laparoscopic common bile duct exploration offers several advantages over endoscopic stone clearance for common bile duct stones with gall stones. However, lack of expertise and a learning curve has often been deterrents to widespread application. This study presents our initial experience and learning curve in managing concomitant cholelithiasis and choledocholithiasis with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE). Methods:
Between January 2016 and January 2020, a total of 51 selected patients with concomitant cholelithiasis and choledocholithiasis underwent LC and LCBDE, and we reviewed our data retrospectively. The primary outcome measure was the common bile duct (CBD) stone clearance rate. Secondary outcome measures were conversion rate, morbidity, mortality and length of hospital stay. Results: A total of 51 selected patients with cholelithiasis and choledocholithiasis underwent LC and LCBDE in a single tertiary care centre over four years. The success rate for laparoscopic stone clearance was 96.07%. The conversion rate was 3.92%. The overall mean duration of the operation was 140 minutes. There was no significant postoperative morbidity and mortality. Hospital stay ranged from 4 to 6 days. Conclusion: For concomitant cholelithiasis and choledocholithiasis, LCBDE is a highly successful single-session minimally invasive procedure and safe even for beginners with basic laparoscopic training and facilities in selected patients.

Keywords: Cholelithiasis, learning curve, laparoscopic cholecystectomy, choledocholithiasis