Peroperative Endoscopic Sphincterotomy

A major aim in the treatment of bile duct stones detected at the time of laparoscopic cholecystectomy should be to remove the stones during the same operation. In most instances, and for patients with small stones, this aim can be achieved using techniques through the cystic duct. In patients in whom these techniques failed, the role of a duodenal approach for removing the stones was evaluated by performing perendoscopic sphincterotomy (PES) and clearing the bile duct via this route. In an initial series of 13 patients, it was demonstrated that perendoscopic sphincterotomy and extraction of stones from the bile duct can be effectively performed in patients in the supine position with minimal interference to the laparoscopic cholecystectomy operation. The perendoscopic approach does not add to the complication rate of the operation, and short-term follow-up of patients indicates no significant postoperative sequalae. This approach adds to the various techniques being developed for the minimal-access approach to the treatment of bile duct stones.