Management of choledocholithiasis encountered during laparoscopic cholecystectomy

To evaluate the prevailing methods of management and assess the safety of laparoscopic treatment of choledocholithiasis, a retrospective review of all common bile duct explorations (CBDE) initiated during laparoscopic cholecystectomy at the Medical College of Georgia was performed. From December 1990 until December 1994, 604 laparoscopic cholecystectomies were performed. In 28 of these patients (26 female, 2 male) with an age range of 17 to 60 years, CBDE was initiated; 21 were performed laparoscopically, and 7 were converted to open CBDE. The procedure was successful in completely clearing the duct of stones in 24 of 28 cases (17 laparoscopic, 7 open). Postoperative endoscopic retrograde cholangiopancreatography was successfully employed in three of the cases of retained stones, and in the fourth, the stone was felt to be small enough to pass without further intervention. Biliary balloon catheters were successfully used to clear the duct in 8 of 17 laparoscopic CBDEs, and a laparoscopic choledochoscope introduced through the cystic duct was used in 7 cases; both were used in 2 cases. The open CBDEs were performed in standard fashion utilizing balloon catheters and choledochoscopy. The only operative complications were the four above-mentioned cases of retained stones. In summary, choledocholithiasis encountered during the course of laparoscopic cholecystectomy can frequently be managed with a laparoscopic CBDE.