Laparoscopic common bile duct exploration: the past, the present, and the future
Section snippets
Transcystic common bile duct exploration
The TC-CBDE technique involves CBDE through the cystic duct, which is incised in its larger portion closer to the CBD so that less cystic duct dilatation is required and quick access to the CBD is gained. The hydrophilic guidewire is then passed into the cystic duct, over which either balloon dilating catheters or sequential bougies are inserted to dilate the cystic duct to the size of the largest calculus. The majority of surgeons avoid dilating the cystic duct beyond 8 mm in diameter because
LCBDE for suspected or proved CBDS: literature review
During the early development of LC, patients with the slightest suspicion of CBDS underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) with a view that if stones were discovered they could be removed either using ES or OCBDE. However, the use of preoperative ERCP is increasingly being challenged because it is costly; in the majority of cases, it is normal18, 19, 20; there is a risk of life-threatening complications such as bleeding (3%), pancreatitis (2%), duodenal
LCBDE versus endoscopic spincterotomy
Liberman et al43 compared LC plus TC-CBDE (group 1) with LC plus ES (group 2) at a single institution. There were 59 patients in group 1 and only 17 patients in group 2. The procedure success rate for group 1 patients was 86% (51 patients). There was 1 conversion due to CBD perforation, 6 known retained stones requiring subsequent ES, and 1 unrecognized retained CBDS. There were 7 complications and 1 death. There were 4 retained stones in group 2, 2 each in pre- and post-ES groups. Seven
Conclusions
Laparoscopic common bile duct exploration is a feasible, safe and effective procedure that carries a low morbidity and mortality. The use of real time on table cholangiography should be used in a selected group of patients (history of jaundice, pancreatitis, and so forth) in order to correctly identify those harbouring CBDS. These patients will require LCBDE at the time of LC. The applicability of LCBDE will be dictated by the suitability of the patient to undergo a more prolonged procedure,
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