A Clinico-Etiology and an Outcome Analysis of Surgical Management of Choledocholithiasis.

Aim To assess the postoperative outcomes of various surgical techniques for choledocholithiasis, such as open common bile duct (CBD) exploration, laparoscopic CBD exploration, and a combined endoscopic and surgical approach, with an emphasis on immediate morbidity and long-term results. Methods This non-randomized prospective observational study was conducted over two years, with a median follow-up of 12 months. The study included 50 patients diagnosed with CBD stones, and their demographic data, preoperative factors, interventions (endoscopic and surgical), and postoperative outcomes were analyzed. Results The mean age of the patients was 53.88±9.49 years and 27 (54%) patients were women. The primary symptom was abdominal pain (49, 98%), followed by jaundice (41, 82%) and fever (15, 30%). Complications related to CBD stones occurred in 15 (32%) cases, including acute cholangitis (11, 22%), gallstone pancreatitis (three, 6%), and choledochoduodenal fistula (two, 4%). Most stones were located in the mid-CBD in 22 (44%) cases and distal CBD in 20 (40%) cases. In terms of quantity, 29 (58%) had multiple stones, while 21 (42%) had one. Regarding the size, 16 (32%) stones were small, 20 (40%) were large, and three (6%) were very large. The mean CBD diameter was 15.09±5.99 mm, with most cases between 15 to 20 mm. The mean total bilirubin was 5.71 mg/dl, direct bilirubin 4.51 mg/dl, alkaline phosphatase 542.50 IU, and the international normalized ratio (INR) was 1.30. A comparative analysis of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic CBD exploration shows both methods produce similar short-term results (stone clearance, postoperative morbidity, hospital stay) and long-term outcomes (stone recurrence, strictures). However, the Laparoscopic Common Bile Duct Exploration (LCBDE) group had a significantly longer operative time, averaging 328±19.24 minutes, compared to 149.09±17.58 minutes for ERCP+LC. Long-term outcomes were also good, with a stricture and stone recurrence rate of 2.94%. A comparison of biliary drainage methods post-open CBD exploration (choledochoduodenostomy, Roux-en-Y hepaticojejunostomy, T-tube repair) showed similar short-term outcomes. The mean operative time for Roux-en-Y was 215±22.76 minutes, longer than choledochoduodenostomy (167.14±22.68 minutes) or T-tube repair (167.50±16.69 minutes). Conclusion Laparoscopic management of CBD stones requires significant expertise and has a steep learning curve. Our study shows that open CBD exploration is effective for complex CBD stone cases, especially after failed ERCP, despite higher short-term morbidity.