PubMed · 1992945
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S S Sikora, V K Kapoor. 1991. 100 consecutive common duct exploration without mortality.. https://pubmed.ncbi.nlm.nih.gov/1992945/
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KEEP EXPLORING
The prevalence of common bile duct stones increases with age. Whereas patients under 60 show a prevalence of 8-15%, the rate increases up to 15-60% > 60 years. The main goal of optimal preoperative diagnosis and treatment of bile duct stones is to avoid unnecessary and negative investigations and to decrease the rate of retained/missed stones. Anamnestic and clinical pointers, laboratory findings and "simple" radiological examinations (ultrasonography, intravenous cholangiography) allow selective preoperative ERCP. The reported clearance rates for ERCP are as high as 95%, with a morbidity and mortality of 3-15% and 0.2-2.5% respectively. Only after endoscopic stone removal should laparoscopic cholecystectomy be added. Laparoscopic bile duct exploration is technically demanding and offers no objective advantages compared to ERCP.
Laparoscopic cholecystectomy has become the procedure of choice for laparoscopically skilled surgeons when dealing with both chronic and acute cholecystitis. When choledocholithiasis is encountered in the treatment of these patients the skilled laparoscopist has several treatment options available to treat the patient in one stage and avoid the morbidity of endoscopic sphincterotomy. Although still controversial, laparoscopic common bile duct exploration has been shown to be safe, applicable, and cost-effective in the treatment of choledocholithiasis. This report details several laparoscopic treatment alternatives for choledocholithiasis.