Laparoscopic Cholecystectomy and Common Bile Duct Exploration

Video case: the management of common bile duct stones in an era of laparoscopic cholecystectomy (LC) remains controversial. Laparoscopic cholecystectomy and common bile duct exploration is a highly successful procedure for the management of common duct stones in an unselected group of patients. Choledochotomy with choledochoscopy is the preferred method of common bile duct exploration. For patients suspected of having common bile duct stones, many surgeons would favor preoperative endoscopic retrograde cholangiopancreatography (ECRP) with extractions of stones (ES), although the incidence of negative, and thus unnecessary, ECRP is high. Another option is intraoperative cholangiography with postoperative ERCP if stones are found, but such a plan necessitates reexploration should the sphincterotomy and the extraction fail. Many, therefore, would advocate conversion to an open procedure if common bile duct stones are noted on the intraoperative cholangiogram. To increase efficency of procedures, many surgeons recommend laparoscopic common bile duct exploration (LCDE) as the most efficient means to manage common bile duct stones.