Introduction : Although the feasibility of biliary by-pass procedures for choledocholithiasis was decreased due to endoscopic or interventional treatment, it is still remained as an important treatment option in specific conditions. In era of laparoscopic surgery, laparoscopic choledochoduodenostomy(LCD) also was applied for difficult common bile duct stones (unresolved by ERCP or PTBD). The aim of this study was to analyze the outcomes of patients with complicated choledocholithiasis treated by laparoscopic choledochoduodenostomy.

Methods : We reviewed our all LCDs done since 2015 in our hospital, documenting our preoperative, intraoperative, and postoperative experience. A successful LCD was performed as a secondary treatment option on all 8 patients.

Results : Four patients had previous episodes of gastrectomy and had been tried PTBD. Others had recurrent episode of choledocholithiasis even after multiple ERCP. We found female predominance (6/8), wide range of age (55-87 years), operative time (180-360min), median lengths of postoperative stay 10 (8-30) days, and a median of 15 (1-35) months of follow-up. Only one patient had a postoperative leakage but spontaneously recovered. The hepatobiliary enzyme levels returned to normal in all of the patients.

Conclusions : LCD with intraoperative cholangioscopic stone remove seems to be safe and effective treatment for patients with recurrent common bile duct stones failed by ERCP or PTBD. LCD is preferable biliary by-pass for choledocholithiasis and technically easier and faster. We suggest that this procedure can be a good option for patients with complicated conditions.