ABSTRACT
Although the incidence of common bile duct stones (CBDS) is relatively low, the presence of CBDS increases the morbidity of biliary surgery fourfold and is potentially life-threatening. While the introduction of therapeutic laparoscopy revolutionized the surgical approach to patients undergoing cholecystectomy, it completely altered the approach to CBDS. Preoperative diagnostic endoscopic retrograde cholangiography (ERC) became the standard for patients suspected of having choledocholithiasis, in order to avoid having to operate on patients with choledocholithiasis discovered during laparoscopic cholecystectomy. Postoperative endoscopic sphincterotomy (ES) became the preferred approach to treat common duct stones encountered at surgery or discovered afterward. In some areas, ERC/ES increased by 243% [1]. In an effort to treat patients with common duct stones in one session and to avoid the potential complications of ES, several techniques of laparoscopic common bile duct exploration (LCBDE) evolved. Hopefully, the treatment of CBDS in patients who are going to need a cholecystectomy will increasingly be managed surgically by these laparoscopic techniques.
