LAPAROSCOPIC COMMON BILE DUCT EXPLORATION
Choledocholithiasis common bile duct (CBD) stones} incidence is around 10% of those patients who present for open cholecystectomy. Definitive treatment of these patients includes cholecystectomy and clearance of the ductal system.This Includes Laparoscopic Cholecystectomy along with Laparoscopic common bile duct exploration to clear the duct system.
Alternative interventional methods (ERCP, dissolution agents, and lithotripsy), to handle CBD stones are present.While these other techniques are certainly useful in managing complicated biliary tract problems, they are not without cost, morbidity, mortality, and significant life-style disruption. Laparoscopic choledocholithotomy may involve a number of
technical maneuvers. Common bile duct stones may be found preoperatively, intraoperatively, or post-operatively.
The clinician must decide whether to attempt ductal treatment, i.e. endoscopic retrograde cholangiography and extraction with or without sphincterotomy, before operation or to proceed directly with laparoscopic cholecystectomy and laparoscopic common duct exploration.
This operation is less commonly indicated because of the widespread availability of ERCP. It is performed when ERCP fails or, when intra-operative cholangiography confirms bile duct stones. It is almost always an adjunct to cholecystectomy and the approach and closure are the same.
"We must move towards a management policy ..., which prevents patients from needing a dangerous and debilitating second operation..."
Biliary tract surgeons practicing in this era should have the ability to treat all benign biliary tract pathology laparoscopically in one setting, not requiring a series of patient manipulations.