Clinical results of common bile duct exploration

Laparoscopic common bile duct exploration has been successfully performed in hundreds of patients throughout the world since early 1990. The author reviews his personal experience with this procedure and compares it with the experience of others as reported in the literature. A variety of methods of managing common duct pathology has been employed. These include balloon-catheter manipulation, fluoroscopically-guided basket extraction, and choledochoscopy. The relative contributions of each of these modalities to the total framework of laparoscopic treatment of common bile duct stones is presented. By these techniques, 83 out of 86 patients had their common duct explored successfully. The author concludes that, based on accumulated experience, most, if not all, common duct stones can be treated and/or removed laparoscopically. In more than 90% of the cases, this can be accomplished through a cystic duct approach, although direct access to the common duct via choledochotomy is also possible. A rational protocol for management of common duct pathology is presented.