• Ahmad H M Nassar, Hwei J Ng, Tarek Katbeh, and Elizabeth Cannings.
• Laparoscopic Biliary Surgery Service, University Hospital Monklands, Lanarkshire, Scotland, United Kingdom.
• Ann. Surg. 2022 Nov 1; 276 (5): e493-e501.

ObjectiveThe primary aim of this study was to describe the service model of one-session management, with a limited role for preoperative endoscopic clearance. The secondary aim was to review the outcomes and long term follow up in comparison to available studies on LCBDE.BackgroundThe laparoscopic era brought about a decline in the conventional surgical management of common bile duct stones. Preoperative endoscopic removal became the primary method of managing choledocholithiasis. Although LCBDE deals with gallstones and ductal stones in onw session, the limited availability of such an advanced procedure perpetuated the reliance on the endoscopic approach.MethodsProspective data was entered into a single surgeon's database containing 5739 laparoscopic cholecystectomy over 28 years and analyzed.ResultsOne thousand eighteen consecutive LCBDE were included (23% of the series). Intraoperative cholangiography was performed in 1292 (98.0%). The median age was 60 years, male to female ratio 1:2 and 75% were emergency admissions. Most patients (43.4%) presented with jaundice. 66% had transcystic explorations and one third through a choledochotomy with 2.1% retained stones, 1.2% conversion, 18.7% morbidity, and 0.2% mortality. Postoperative ERCPs were needed in 3.1%. Recurrent stones occurred in 3%.ConclusionsOne stage LCBDE is a safe and cost-effective treatment where the expertise and equipment are available. Endoscopic treatment has a role for specific indications but remains the first-line treatment in most units. This study demonstrates that establishing specialist services through training and logistic support can optimize the outcomes of managing common bile duct stones.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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