{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T23:28:08Z","timestamp":1793316488690,"version":"4.5.0"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>This retrospective cohort study evaluated the efficacy of laparoscopic common bile duct exploration (LCBDE) for managing difficult common bile duct stones (CBDSs) in patients with failed endoscopic retrograde cholangiopancreatography (ERCP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>Forty-two patients underwent LCBDE between 2019 and 2024, after unsuccessful ERCP. The causes of ERCP failure include cannulation failure, large stones, impacted stones and multiple stones. The surgical technique involved a standard 4-port laparoscopic cholecystectomy with an additional port for manipulation of the Fogarty catheter or choledochoscope. Stones were extracted by milking the CBD, using a Fogarty balloon catheter or with the aid of a choledochoscope. The choledochotomy was closed primarily or over the stent using interrupted or continuous sutures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean CBD diameter was 14.8 mm (range: 12\u201333 mm), with 31 patients having single stones and 11 having multiple stones. Two patients were suspected to have CBD strictures. CBD clearance was achieved in 38 (90.5%) patients. In four patients, the procedure was converted to open because of an impacted stone. Post-operative complications included bile leak (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 2) and residual stones (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 2). It was also observed that primary closure of the choledochotomy without drainage does not affect the outcome.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study demonstrated that LCBDE is a safe and effective minimally invasive option for managing difficult CBDS when ERCP fails.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmas.jmas_23_25","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T13:00:30Z","timestamp":1758200430000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Laparoscopic common bile duct exploration for managing difficult common bile duct stones after failed endoscopic retrograde cholangiopancreatography"],"prefix":"10.4103","author":[{"given":"Sanjay","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Surgery, Government Medical College and Hospital, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaina","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Government Medical College and Hospital, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishan","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Government Medical College and Hospital, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok K.","family":"Attri","sequence":"additional","affiliation":[{"name":"Department of Surgery, Government Medical College and Hospital, Chandigarh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"R1-20250918","doi-asserted-by":"crossref","first-page":"165","DOI":"10.3748\/wjg.v19.i2.165","article-title":"Endoscopic management of difficult common bile duct stones","volume":"19","author":"Trikudanathan","year":"2013","journal-title":"World J Gastroenterol"},{"key":"R2-20250918","doi-asserted-by":"crossref","first-page":"1613","DOI":"10.1007\/s10620-022-07424-9","article-title":"Management of difficult choledocholithiasis","volume":"67","author":"Podboy","year":"2022","journal-title":"Dig Dis Sci"},{"key":"R3-20250918","doi-asserted-by":"crossref","first-page":"7597","DOI":"10.3748\/wjg.v27.i44.7597","article-title":"Endoscopic management of difficult common bile duct stones: Where are we now? 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