Introduction: The selection of treatment for common bile duct stones (CBDS) is guided by multiple factors. Endoscopic retrograde cholangiopancreatography (ERCP) has emerged as the preferred alternative to open surgery. The failure rate of ERCP can be as high as 10% to 25%. Our study aims to identify the characteristics of CBD stones, which make them prone to failure by standardised ERCP extraction helping to prevent the morbidity associated with failed ERCPs and compare the different techniques of treatment with a special focus on the various surgical modalities.

Material and Method: In this prospective observational study 30 Patients who presented to Surgery OPD with choledocholithiasis not amenable to ERCP stone retrieval were included. Clinical presentation and examination findings, radiological investigation, stone characteristics, CBD characteristics, reasons for failed ERCP, surgical procedure undergone, postoperative complications, hospital stay, physical and mental score were analysed in detail.

Result: In our study reasons for failed ERCP includes multiple calculi seen in 40% of cases followed by large calculi in 23.3%, impacted stone in 13.3%, stricture in 10%, diverticulum in 2 cases and difficult cannulation in 1 case. Out of 30, 25 patients underwent open and 5 underwent laparoscopic CBD exploration. The mean length of hospital stay among open and laparoscopic surgery group was 6 & 5 days respectively. The average Physical status awell score in case of open CBD exploration was 43.57 and in laparoscopic was 49.46 and the average mental status awell score in case of open CBD exploration was 46.07 and in laparoscopic was 52.45.

Conclusion: There is no significant difference in the clinical outcomes between Open CBD Exploration with primary repair or T-tube or Choledochoenterostomy and Laparoscopic CBD Exploration, except for the Physical and mental status, which is higher in laparoscopic CBD exploration patients. The ideal management of choledocholithiasis remains controversial, but the treatment for choledocholithiasis must always be tailored to the needs of each patient.