Effectiveness of laser lithotripsy-assisted bile duct surgery for complex choledocholithiasis: A prospective study

Abstract

Background: Choledocholithiasis remains a prevalent condition in hepatobiliary surgery, particularly in Southeast Asia. While several treatment modalities exist, achieving complete stone clearance remains challenging, especially in cases with intrahepatic or impacted stones. Intraoperative cholangioscopy combined with laser lithotripsy has emerged as a promising approach to improve outcomes. Materials and methods: This prospective study included 28 patients with intra- or extrahepatic bile duct stones who underwent open bile duct surgery combined with flexible cholangioscopy and holmium:YAG laser lithotripsy at Hai Phong University of Medicine and Pharmacy Hospital from June 2023 to April 2025. Demographic data, clinical and laboratory findings, operative details, complications, and treatment outcomes were recorded and analyzed descriptively. Results: The mean patient age was 52.3 ± 9.9 years, with 64.3% having a history of biliary surgery. All patients experienced right upper quadrant pain, and Charcot’s triad was observed in 35.7%. Multiple stones were present in 82.1% cases, and 53.6% had cast-like stones. Intraoperatively, complete stone clearance was achieved in 85.6% of cases. Residual stones were predominantly located in the intrahepatic ducts. The mean operative time was 98.2 ± 21.1 minutes, and the mean hospital stay was 11.4 ± 4.8 days. Postoperative complications occurred in 21.4% of patients, with bile leakage being the most common (7.1%). Overall, 78.6% of patients achieved good clinical outcomes. Conclusions: Open bile duct surgery combined with intraoperative cholangioscopy and laser lithotripsy is a safe and effective method for managing complex choledocholithiasis, offering a high stone clearance rate and acceptable complication profile. Broader implementation of this technique may require increased access to specialized equipment and surgical expertise.