Laparoscopic Common Bile Duct Exploration Using Flexible Ureteroscope: Ain Shams University Experience | ||||
| Ain Shams Journal of Surgery | ||||
| Volume 18, Issue 2, April 2025, Page 157-161 PDF (473.14 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/asjs.2025.366712.1193 | ||||
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| Authors | ||||
Mohamed A. Abdel Hamid; Mohamed Gamal Qassem ; Mohammad Ahmad Abd-erRazik 
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| Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt | ||||
| Abstract | ||||
| Introduction: Choledocholithiasis remains a common complication of gallstone disease, with endoscopic retrograde cholangiopancreatography (ERCP) being the current gold standard for management. However, ERCP has limitations, particularly in cases involving large or impacted stones. Laparoscopic common bile duct exploration (LCBDE) using flexible choledochoscopes offers an alternative but is underutilized due to high costs. This study evaluates the feasibility, safety, and short-term outcomes of LCBDE using flexible ureteroscopes as a cost-effective alternative. Patients and methods: This prospective observational study included 15 patients with choledocholithiasis who had previously failed ERCP and underwent LCBDE assisted by a flexible ureteroscope at Ain Shams University Hospital between October 2023 and September 2024. Procedures were performed using standardized laparoscopic techniques, with stone retrieval achieved by using flexible ureteroscope. Technical success was defined as complete stone clearance with primary closure of the CBD. Results: The mean age of the cohort was 52.1±9.7 years, with males representing 60% of the patients. The mean operative time was 163.3±29.2 minutes, and the mean hospital stay was 5.1±1.0 days. Blood loss averaged 168.7±85.4 mL. Technical success was achieved in 14 out of 15 patients (93.3%), with one case requiring conversion to open surgery due to stone impaction. Complications occurred in 13.3% of patients, including one instance of biliary leakage managed conservatively and one missed stone detected during follow-up, which was resolved via ERCP. Conclusion: Flexible ureteroscopy-assisted LCBDE is a feasible, safe, and effective option for managing choledocholithiasis, particularly in resource-constrained settings. While further studies with larger cohorts and longer follow-up periods are needed to evaluate long-term outcomes, this technique holds promise for addressing gaps in hepatobiliary care access. | ||||
| Keywords | ||||
| Laparoscopic common bile duct exploration; flexible ureteroscopy; choledocholithiasis; resource-constrained settings; cost-effectiveness | ||||
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