Laparoscopic common duct exploration in the management of choledocholithiasis

BACKGROUND: Optimal treatment strategies for addressing common duct stones at laparoscopic cholecystectomy remain controversial. The study presents the authors' experience with laparoscopic common bile duct exploration (LCBDE). METHODS: A retrospective review was performed of 71 LCBDEs performed over 5 years using either transcystic duct flushing and mechanical techniques, transcystic duct basket retreival techniques, or laparoscopic choledochotomy. RESULTS: Laparoscopic CBDE resulted in ductal clearance in 61 of 71 (85%) cases with only 1 case of unsuspected retained common duct stones and only 1 major complication. Review of the cases that did not result in common duct clearance suggests that the success rate of laparoscopic CBDE could be increased. CONCLUSIONS: Laparoscopic CBDE is an effective treatment for concurrent gallstones and common duct stones and avoids the potential morbidity of an endoscopic sphincterotomy. General surgeons with adequate training and experience can perform laparoscopic CBDE safely and effectively.