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Abstract
There is no doubt that laparoscopic cholecystectomy (LC) remains the gold standard for gall bladder removal with low complication rates and routine day case surgery is now a reality for this procedure. (Leeder PC et al,2004).
Common bile duct stones are found in approximately 9% to 16% of patients undergoing laparoscopic cholecystectomy.
(Petelin J,2003).
The ideal management of common bile duct (CBD) stones in the era of laparoscopic cholecystectomy remains controversial. Options range from endoscopic retrograde cholangiography (ERCP) in all or selected patients, through the clearance of the BD through the cyctic duct or via laparoscopic common bile duct exploration.(Turcu F,1997).
If the diagnosis of choledocholithiasis is made at the preoperative workup, it is common practice to refer the patient for endoscopic retrograde cholangiography and endoscopic sphincterotomy (ERC+S). However, if the diagnosis is established during intraoperative cholangiography, the surgeon is confronted with a therapeutic dilemma—that is, the choice between laparoscopic common bile duct exploration, conversion to open surgery, or postoperative endoscopic sphincterotomy (Trias M et al,1997).
Clinical management of (CBD) stones in the last decade has focused on precholecystectomy detection with ERCP clearance in those with suspected stones. This clinical algorithm successfully clears the stones in most patients, but no stones are found in 20% to 60% of patients, and rare unpredictable severe morbidity can result in this group. (Wilson TG et al,1993).