Surgical Endoscopy

, Volume 32, Issue 6, pp 2603–2612 | Cite as

Laparoscopic common bile duct exploration

  • Marc Zerey
  • Stephen Haggerty
  • William Richardson
  • Byron Santos
  • Robert Fanelli
  • L. Michael Brunt
  • Dimitrios Stefanidis
SAGES Official Publication


The following clinical spotlight review regarding the laparoscopic treatment of common bile duct stones is intended for physicians who manage and treat gallbladder disease and choledocholithiasis. It is meant to critically review these techniques and the available evidence regarding their safety and efficacy. Provided recommendations for clinical practice are linked to the level of available evidence, and where evidence is lacking expert opinion is offered.


Guidelines for clinical practice and spotlight reviews are intended to indicate preferable approaches to medical problems as established by experts in the field. These recommendations will be based on existing data or a consensus of expert opinion when little or no data are available. Spotlight reviews are applicable to all physicians who address the clinical problem(s) without regard to specialty training or interests and are intended to convey recommendations based on a focused topic; within the defined scope...


Compliance with ethical standards


Stephen Haggerty reports teaching honorarium from RL Gore. Robert Fanelli reports Royalties from Product Development, Cook, Inc. William Richardson, Byron Santos, L. Michael Brunt, Dimitrios Stefanidis and Marc Zerey have no conflicts of interest or financial ties to disclose.


  1. 1.
    Fitzgibbons RJ Jr, Gardner GC (2001) Laparoscopic surgery and the common bile duct. World J Surg 25(10):1317–1324CrossRefPubMedGoogle Scholar
  2. 2.
    Bailey RW et al (1991) Laparoscopic cholecystectomy. Experience with 375 consecutive patients. Ann Surg 214(4):531–540 (discussion 540–1)CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Graham SM et al (1993) Laparoscopic cholecystectomy and common bile duct stones. The utility of planned perioperative endoscopic retrograde cholangiography and sphincterotomy: experience with 63 patients. Ann Surg 218(1):61–67CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Collins C et al (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239(1):28–33CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Litynski GS (1998) Erich Muhe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 2(4):341–346PubMedPubMedCentralGoogle Scholar
  6. 6.
    Kane RL et al (1995) The outcomes of elective laparoscopic and open cholecystectomies. J Am Coll Surg 180(2):136–145PubMedGoogle Scholar
  7. 7.
    Williams LF Jr et al (1993) Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center. Am J Surg 165(4):459–465CrossRefPubMedGoogle Scholar
  8. 8.
    Sawyers JL (1996) Current status of conventional (open) cholecystectomy versus laparoscopic cholecystectomy. Ann Surg 223(1):1–3CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Stain SC et al (1991) Choledocholithiasis. Endoscopic sphincterotomy or common bile duct exploration. Ann Surg 213(6):627–633 (discussion 633–4)CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Heinerman PM, Boeckl O, Pimpl W (1989) Selective ERCP and preoperative stone removal in bile duct surgery. Ann Surg 209(3):267–272CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Ponsky JL (1992) Endoscopic management of common bile duct stones. World J Surg 16(6):1060–1065CrossRefPubMedGoogle Scholar
  12. 12.
    Fink AS (1993) Current dilemmas in management of common duct stones. Surg Endosc 7(4):285–291CrossRefPubMedGoogle Scholar
  13. 13.
    Shapiro SJ et al (1991) Laparoscopic exploration of the common bile duct: experience in 16 selected patients. J Laparoendosc Surg 1(6):333–341CrossRefPubMedGoogle Scholar
  14. 14.
    Pereira-Lima JC et al (1998) Long-term results (7 to 10 years) of endoscopic papillotomy for choledocholithiasis. Multivariate analysis of prognostic factors for the recurrence of biliary symptoms. Gastrointest Endosc 48(5): 457–464CrossRefPubMedGoogle Scholar
  15. 15.
    Bansal VK et al (2013) Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial. Surg Endosc. PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Noble H et al (2009) A randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech A 19(6):713–720CrossRefPubMedGoogle Scholar
  17. 17.
    Sgourakis G, Karaliotas K (2002) Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study. Minerva Chir 57(4):467–474PubMedGoogle Scholar
  18. 18.
    Cuschieri A et al (1999) E.A.E.S. multicenter prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi. Surg Endosc 13(10):952–957CrossRefPubMedGoogle Scholar
  19. 19.
    Nathanson LK et al (2005) Postoperative ERCP versus laparoscopic choledochotomy for clearance of selected bile duct calculi: a randomized trial. Ann Surg 242(2):188–192CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Koc B et al (2013) Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg 206(4):457–463CrossRefPubMedGoogle Scholar
  21. 21.
    Liberman MA et al (1996) Cost-effective management of complicated choledocholithiasis: laparoscopic transcystic duct exploration or endoscopic sphincterotomy. J Am Coll Surg 182(6):488–494PubMedGoogle Scholar
  22. 22.
    Berci G, Morgenstern L (1994) Laparoscopic management of common bile duct stones. A multi-institutional SAGES study. Society of American Gastrointestinal Endoscopic Surgeons. Surg Endosc 8(10):1168–1174 (discussion 1174–5).CrossRefPubMedGoogle Scholar
  23. 23.
    Petelin JB (2003) Laparoscopic common bile duct exploration. Surg Endosc 17(11):1705–1715CrossRefPubMedGoogle Scholar
  24. 24.
    Phillips EH et al (1994) Laparoscopic trans-cystic-duct common-bile-duct exploration. Surg Endosc 8(12):1389–1393 (discussion 1393–4).CrossRefPubMedGoogle Scholar
  25. 25.
    Petelin JB (1997) Techniques and cost of common bile duct exploration. Semin Laparosc Surg 4(1):23–33PubMedGoogle Scholar
  26. 26.
    Phillips EH (1998) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 12(4):365–366CrossRefPubMedGoogle Scholar
  27. 27.
    Vecchio R, MacFadyen BV (2002) Laparoscopic common bile duct exploration. Langenbecks Arch Surg 387(1):45–54CrossRefPubMedGoogle Scholar
  28. 28.
    Crawford DL, Phillips EH (1999) Laparoscopic common bile duct exploration. World J Surg 23(4):343–349CrossRefPubMedGoogle Scholar
  29. 29.
    Petelin JB (1993) Laparoscopic approach to common duct pathology. Am J Surg 165(4):487–491CrossRefPubMedGoogle Scholar
  30. 30.
    Lyass S, Phillips EH (2006) Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 20(Suppl 2):S441–S445CrossRefPubMedGoogle Scholar
  31. 31.
    Kroh M, Chand B (2008) Choledocholithiasis, endoscopic retrograde cholangiopancreatography, and laparoscopic common bile duct exploration. Surg Clin North Am 88(5):1019–1031, viiCrossRefPubMedGoogle Scholar
  32. 32.
    Grubnik VV et al (2012) Laparoscopic common bile duct exploration versus open surgery: comparative prospective randomized trial. Surg Endosc 26(8):2165–2171CrossRefPubMedGoogle Scholar
  33. 33.
    ElGeidie A et al (2015) Laparoscopic bile duct clearance without choledochoscopy. Surg Laparosc Endosc Percutan Tech 25(5):e152–e155CrossRefPubMedGoogle Scholar
  34. 34.
    Topal B, Aerts R, Penninckx F (2007) Laparoscopic common bile duct stone clearance with flexible choledochoscopy. Surg Endosc 21(12):2317–2321CrossRefPubMedGoogle Scholar
  35. 35.
    Gupta N (2016) Role of laparoscopic common bile duct exploration in the management of choledocholithiasis. World J Gastrointest Surg 8(5):376–381CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Phillips E et al (2015) The role of choledochoscopy: the eternal problem of how to remove a CBD stone. Surg Innov 22(5):540–545CrossRefPubMedGoogle Scholar
  37. 37.
    Yin Z et al (2013) Is the end of the T-tube drainage era in laparoscopic choledochotomy for common bile duct stones is coming? A systematic review and meta-analysis. Ann Surg 257(1):54–66CrossRefPubMedGoogle Scholar
  38. 38.
    Swanstrom LL (1993) Laparoscopic approaches to the common bile duct stone: transcystic bile duct exploration, choledochotomy and stone fragmentation. Baillieres Clin Gastroenterol 7(4):897–919CrossRefPubMedGoogle Scholar
  39. 39.
    Martin CJ, Cox MR, Vaccaro L (2002) Laparoscopic transcystic bile duct stenting in the management of common bile duct stones. ANZ J Surg 72(4):258–264CrossRefPubMedGoogle Scholar
  40. 40.
    Fanelli RD, Gersin KS (2001) Laparoscopic endobiliary stenting: a simplified approach to the management of occult common bile duct stones. J Gastrointest Surg 5(1):74–80CrossRefPubMedGoogle Scholar
  41. 41.
    Morino M et al (2006) Preoperative endoscopic sphincterotomy versus laparoendoscopic rendezvous in patients with gallbladder and bile duct stones. Ann Surg 244(6):889–893 (discussion 893–6)CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Rabago LR et al (2006) Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis. Endoscopy 38(8):779–786CrossRefPubMedGoogle Scholar
  43. 43.
    Chan E, Neeman T, Thomson A (2016) Follow-up to determine unplanned hospitalization and complications after endoscopic retrograde cholangiopancreatography. ANZ J Surg. CrossRefPubMedGoogle Scholar
  44. 44.
    Gurusamy KS, Koti R, Davidson BR (2013) T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Cochrane Database Syst Rev 6:CD005641Google Scholar
  45. 45.
    Khaled YS et al (2013) Laparoscopic bile duct exploration via choledochotomy followed by primary duct closure is feasible and safe for the treatment of choledocholithiasis. Surg Endosc 27(11):4164–4170CrossRefPubMedGoogle Scholar
  46. 46.
    Lyon M et al (2015) Use of biliary stent in laparoscopic common bile duct exploration. Surg Endosc 29(5):1094–1098CrossRefPubMedGoogle Scholar
  47. 47.
    Alhamdani A et al (2008) Primary closure of choledochotomy after emergency laparoscopic common bile duct exploration. Surg Endosc 22(10):2190–2195CrossRefPubMedGoogle Scholar
  48. 48.
    Stoker ME (1995) Common bile duct exploration in the era of laparoscopic surgery. Arch Surg 130(3):265–268 (discussion 268–9).CrossRefPubMedGoogle Scholar
  49. 49.
    Campagnacci R et al (2010) Is laparoscopic fiberoptic choledochoscopy for common bile duct stones a fine option or a mandatory step? Surg Endosc 24(3):547–553CrossRefPubMedGoogle Scholar
  50. 50.
    Zhu JG et al (2015) Learning curve and outcome of laparoscopic transcystic common bile duct exploration for choledocholithiasis. Br J Surg 102(13):1691–1697CrossRefPubMedGoogle Scholar
  51. 51.
    Herrero A et al (2013) Does the surgeon’s experience influence the outcome of laparoscopic treatment of common bile duct stones? Surg Endosc 27(1):176–180CrossRefPubMedGoogle Scholar
  52. 52.
    Campbell-Lloyd AJ, Martin DJ, Martin IJ (2008) Long-term outcomes after laparoscopic bile duct exploration: a 5-year follow up of 150 consecutive patients. ANZ J Surg 78(6):492–494CrossRefPubMedGoogle Scholar
  53. 53.
    Giurgiu DI et al (1999) Laparoscopic common bile duct exploration: long-term outcome. Arch Surg 134(8):839–843 (discussion 843–4)CrossRefPubMedGoogle Scholar
  54. 54.
    Waage A et al (2003) Long-term results from laparoscopic common bile duct exploration. Surg Endosc 17(8):1181–1185CrossRefPubMedGoogle Scholar
  55. 55.
    ElGeidie AA, ElShobary MM, Naeem YM (2011) Laparoscopic exploration versus intraoperative endoscopic sphincterotomy for common bile duct stones: a prospective randomized trial. Dig Surg 28(5–6):424–431CrossRefPubMedGoogle Scholar
  56. 56.
    Griniatsos J, Karvounis E, Isla A (2005) Early versus delayed single-stage laparoscopic eradication for both gallstones and common bile duct stones in mild acute biliary pancreatitis. Am Surg 71(8):682–686PubMedGoogle Scholar
  57. 57.
    Gu AD et al (2011) Comparative evaluation of two laparoscopic procedures for treating common bile duct stones. Cell Biochem Biophys 59(3):159–164CrossRefPubMedGoogle Scholar
  58. 58.
    Hong DF, Xin Y, Chen DW (2006) Comparison of laparoscopic cholecystectomy combined with intraoperative endoscopic sphincterotomy and laparoscopic exploration of the common bile duct for cholecystocholedocholithiasis. Surg Endosc 20(3):424–427CrossRefPubMedGoogle Scholar
  59. 59.
    Lien HH et al (2005) Laparoscopic common bile duct exploration with T-tube choledochotomy for the management of choledocholithiasis. J Laparoendosc Adv Surg Tech A 15(3):298–302CrossRefPubMedGoogle Scholar
  60. 60.
    Meyer C et al (1999) Management of common bile duct stones by laparoscopic cholecystectomy and endoscopic sphincterotomy: pre-, per- or postoperative sphincterotomy? Dig Surg 16(1):26–31CrossRefPubMedGoogle Scholar
  61. 61.
    Alexakis N, Connor S (2012) Meta-analysis of one- vs. two-stage laparoscopic/endoscopic management of common bile duct stones. HPB 14(4):254–259CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Dasari BV et al (2013) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 9:CD003327Google Scholar
  63. 63.
    Lai EC et al (1992) Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 326(24):1582–1586CrossRefPubMedGoogle Scholar
  64. 64.
    Newman KD, Powell DM, Holcomb GW 3rd (1997) The management of choledocholithiasis in children in the era of laparoscopic cholecystectomy. J Pediatr Surg 32(7):1116–1119CrossRefPubMedGoogle Scholar
  65. 65.
    Poffenberger CM et al (2012) Cholelithiasis and its complications in children and adolescents: update and case discussion. Pediatr Emerg Care 28(1):68–76 (quiz 77–8).CrossRefPubMedGoogle Scholar
  66. 66.
    Mah D et al (2004) Management of suspected common bile duct stones in children: role of selective intraoperative cholangiogram and endoscopic retrograde cholangiopancreatography. J Pediatr Surg 39(6):808–812 (discussion 80812)CrossRefPubMedGoogle Scholar
  67. 67.
    Short SS et al (2013) Laparoscopic common bile duct exploration in children is associated with decreased cost and length of stay: results of a two-center analysis. J Pediatr Surg 48(1):215–220CrossRefPubMedGoogle Scholar
  68. 68.
    Hill SJ et al (2014) Management of the pediatric patient with choledocholithiasis in an era of advanced minimally invasive techniques. J Laparoendosc Adv Surg Tech A 24(1):38–42CrossRefPubMedGoogle Scholar
  69. 69.
    Buchwald H, Oien DM (2013) Metabolic/bariatric surgery worldwide 2011. Obes Surg 23(4):427–436CrossRefPubMedGoogle Scholar
  70. 70.
    Villegas L et al (2004) Is routine cholecystectomy required during laparoscopic gastric bypass? Obes Surg 14(2):206–211CrossRefPubMedGoogle Scholar
  71. 71.
    Kuga R et al (2008) ERCP using double-balloon enteroscopy in patients with Roux-en-Y anatomy. Dig Dis 26(4):330–335CrossRefPubMedGoogle Scholar
  72. 72.
    Richardson JF et al (2012) Laparoscopic transgastric endoscopy after Roux-en-Y gastric bypass: case series and review of the literature. Am Surg 78(10):1182–1186PubMedGoogle Scholar
  73. 73.
    Nguyen NT et al (2007) Laparoscopic transgastric access to the biliary tree after Roux-en-Y gastric bypass. Obes Surg 17(3):416–419CrossRefPubMedGoogle Scholar
  74. 74.
    Marchesini JCD et al (2017) Transenteric ERCP for treatment of choledocholithiasis after duodenal switch. Surg Laparosc Endosc Percutan Tech 27(3):e28–e30CrossRefPubMedGoogle Scholar
  75. 75.
    Tucker O et al (2008) Management of choledocholithiasis after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 4(5):674–678CrossRefPubMedGoogle Scholar
  76. 76.
    Poulose BK, Arbogast PG, Holzman MD (2006) National analysis of in-hospital resource utilization in choledocholithiasis management using propensity scores. Surg Endosc 20(2):186–190CrossRefPubMedGoogle Scholar
  77. 77.
    Teitelbaum EN et al (2014) A simulator-based resident curriculum for laparoscopic common bile duct exploration. Surgery 156(4):880–887, 890–893CrossRefPubMedGoogle Scholar
  78. 78.
    Sanchez A et al (2012) Laparoscopic common bile duct exploration four-task training model: construct validity. JSLS 16(1):10–15CrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Santos BF et al (2012) Development and evaluation of a laparoscopic common bile duct exploration simulator and procedural rating scale. Surg Endosc 26(9):2403–2415CrossRefPubMedGoogle Scholar
  80. 80.
    Sanchez A et al (2010) Development of a training model for laparoscopic common bile duct exploration. JSLS 14(1):41–47CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) 2017

Authors and Affiliations

  • Marc Zerey
    • 1
  • Stephen Haggerty
    • 2
  • William Richardson
    • 3
  • Byron Santos
    • 4
  • Robert Fanelli
    • 5
  • L. Michael Brunt
    • 6
  • Dimitrios Stefanidis
    • 7
  1. 1.Sansum ClinicSanta BarbaraUSA
  2. 2.NorthShore University HealthSystemEvanstonUSA
  3. 3.Ochsner ClinicNew OrleansUSA
  4. 4.Dartmouth-Hitchcock Medical CenterLebanonUSA
  5. 5.Guthrie ClinicSayreUSA
  6. 6.Washington University School of MedicineSt. LouisUSA
  7. 7.Indiana University – Purdue University IndianapolisIndianapolisUSA

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