Laparoscopic choledochoscopy and choledocholithotomy

Laparoscopic cholecystectomy is rapidly replacing traditional cholecystectomy as the treatment of choice for patients with cholelithiasis. Complications of cholelithiasis are likewise being treated laparoscopically. Choledocholithiasis represents a major challenge for the laparoscopic surgeon. This report is of the early experience with laparoscopy as the primary treatment of common bile duct stones. Two methods are described: (a) transcystic duct choledochoscopy and (b) laparoscopic choledochotomy. Twenty-two patients were encountered with choledocholithiasis (4.8% of total cholecystectomies). Successful laparoscopic choledocholithotomy was performed in 18 cases (82%). Techniques and options are discussed.