Introduction : Laparoscopic common bile duct exploration (LCBDE) has been proven to be a technically demanding but cost-effective option for the management of common bile duct (CBD) stones. It can be performed trans-cystically for stones that are small (10mm). Laparoscopic trans-choledochal CBD exploration requires more technical skills and it is also associated with specific complications e.g. bile duct stricture, bile leak and rarely injury to the posterior wall of CBD or injury to portal vein

Methods : In Changi General Hospital, CBD exploration for CBD stones is usually reserved for stones failed to be removed via endoscopic retrograde cholangiopancreatography (ERCP) or stones identified on intraoperative cholangiogram (IOC). The patients who had laparoscopic trans-choledochal CBD exploration were retrospectively reviewed. The techniques and complications of trans-choledochal LCBDE were described.

Results : We identified 2 cases with complications. First one had bile leak from the choledochotomy site, requiring to undergo ERCP and stenting postoperatively. The second one had a very rare posterior CBD wall injury during choledochotomy, which was converted to open biliary bypass.

Conclusions : Laparoscopic trans-choledochal CBD exploration is technically demanding. Care should be taken during choledochotmy. This technique should be reserved for cases with dilated CBD.