Laparoscopic transcystic choledochoscopy

Abstract

Preoperative prediction of common bile duct stones (CBDS) is imprecise. Cholangiography during laparoscopic cholecystectomy (LC) is the best method for detection of CBDS. Treatment of most stones detected at LC can be safely accomplished using transcystic choledochoscopy and stone extraction. This technique is applicable in nearly 90% of patients with CBD calculi. It may be preferable to endoscopic sphincterotomy (ES) in younger patients and is probably equivalent to ES in patients over 65 years of age.

Combined endoscopic treatment for cholelithiasis associated with choledocholithiasis

“…The use of a guidewire, allowing an anterograde cannulation of the papilla, avoids the risk of inadvertent cannulation of the pancreatic duct, with possible related complications. Laparoscopic transcystic duct exploration [3,4,11] or laparoscopic choledochotomy [9,10] and duct exploration are alternative methods of duct clearance. Transcystic duct exploration should always be attempted first, but it may not always result in successful narrowing of the cystic duct lumen.…”

Must ERCP Be Routinely Performed if Choledocholithiasis Is Suspected?

“…CBD stones could be then removed laparoscopically or postoperatively by ERCP. Laparoscopic duct exploration has the advantage of a one-stage procedure for the patient found to have ductal stones at surgery, but it requires advanced laparoscopic skills [18, 19]. A laparoscopic approach to the bile duct is just as effective as combined ERCP-LC with similar morbidity and has a significantly shorter hospital stay [20].…”

A stratified intraoperative surgical strategy is mandatory during laparoscopic common bile duct exploration for common bile duct stones Lessons and limits from an initial experience of 92 patients

“…The development of laparoscopic surgery has worsened the confusion. However, the efficacy and safety of laparoscopic CBDE [4,8,11,13,16,20,22,27,29,30] as well as the value of preoperative ES before laparoscopic cholecystectomy (LC) [3, 15, 17-19, 26, 33, 34] have been increasingly reported.After a surgical experience with open CBDE involving about 500 patients, in 1990 we started a prospective consecutive evaluation of the laparoscopic approach in patients with CBDS. The present series is taken from a part of a total experience of 2,500 LCs performed by the two senior auCorrespondence to:…”

“…The development of laparoscopic surgery has worsened the confusion. However, the efficacy and safety of laparoscopic CBDE [4,8,11,13,16,20,22,27,29,30] as well as the value of preoperative ES before laparoscopic cholecystectomy (LC) [3, 15, 17-19, 26, 33, 34] have been increasingly reported.…”