Difficult common bile duct stones

Background: Single-stage procedure for the treatment of choledocholithiasis by laparoscopy is associated with high success rate in most cases. Difficult common bile duct stones are an exception to this rule.Objective: The aim of this study is to describe the results obtained with the management of difficult common bile duct stones.Material and methods: We conducted a retrospective review of a consecutive series of cases of difficult common bile duct stones treated between 2018-2020.Results: Eight patients fulfilled the inclusion criteria. Of the 5 patients managed with single-stage approach through video-assisted laparoscopy, 60% required conversion to open surgery. The other 3 cases were initially managed with endoscopic cholangiography due to severe cholangitis and were solved with elective transcystic instrumentation.Conclusion: This initial experience suggests that the two-stage approach could be better to treat difficult common bile duct stones with a minimally invasive approach.