Background and aim: 10-18% of people undergoing cholecystectomy have common bile duct (CBD) stones. Treatment may be: open CBD exploration, laparoscopic CBD exploration (LCBDE), or pre- or post-cholecystectomy ERCP in two stages. The aim of this study is to compare CBD clearance by these procedures

Patients and methods: 250 cases of choledocholithiasis were included from Sohag and Assuit university hospitals.

Results: Ages were 20-60 years with slight female predominance (1.6: 1), most of them presented with calcular obstruction (54.3%). Patients were categorized randomly into 3 groups:

Group I: 100 patients (40%) were treated by open choledocholithotomy and T tube insertion, operative time was 90 (60-180) min. with success rate 100%. CBD clearance was achieved in 95%, hospital stay was 8 (5-12) days with no mortality. Morbidity rate of 15% as wound infection, bile leak, and missed stone. Patients can return to work after 2 weeks (12-20 days).

Group II: 100 cases (40%) were treated by endoscopic sphincterotomy and stone retrieval, time was 30 (20-45) min. with success rate 98% and CBD clearance was achieved by 100%, with no mortality. Morbidity rate was 9% as cholangitis (3%) and mild pancreatitis (6%). Hospital stay was 1 (1-2) days, and return to work after 3 (2-5) days.

Group III: 50 cases (20%) treated by LCBDE either trans-cystic in 5 cases, or trans-choledochotomy in 45 cases. Choledochoscopy was done in 45 cases. Time was 123 (70-292) min. with CBD clearance in 96%, with no mortality. Morbidity rate 10% as mild hyperamylasemia, fever, and missed stone. Hospital stay was 3.2 (2-4) days, and return to the work after 7 (5-10) days.

Conclusion: Both ERCP/LC and LCBDE were highly effective, and equivalent in overall cost and patient acceptance. However, hospitalization was shorter for LCBDE with elimination of the potential risks of ERCP associated pancreatitis, further procedure, and anesthesia risks. It is feasible, cost-effective, and ultimately should be available for patients in specialized center.