Common duct exploration during laparoscopic cholecystectomy

Management of a common duct stone detected during laparoscopic cholecystectomy remains controversial. Although endoscopic retrograde cholangiopancreatography with sphincterotomy is a procedure preferred by many authors, it has a reported 15 per cent reported morbidity, 1 per cent mortality, 5 per cent failure rate, and 5 per cent incidence of late ampullary stenosis. Cystic duct dilatation with the introduction of a choledoscope and a basket remains an alternative but has a risk of a common duct tear and difficulty in manipulation of instrument should the cystic duct enter the common duct at an angle, and it causes difficulty in extraction of larger stones. In our experience, a choledochotomy with removal of stones during the laparoscopic cholecystectomy is a satisfactory direct approach. We reviewed all of the cholecystectomies performed in the regional hospital since the introduction of the laparoscopic technique. There were 425 cases of laparoscopic cholecystectomies performed with cholangiography, with detection of a stone in 11 patients. In these patients, choledochotomies were performed by making an incision on the anterior surface of the common duct using scissors. The cystic duct should not be divided following cholangiography since provided traction. Following exploration using a Fogarty catheter, a T tube was placed, and a T tube cholangiogram was performed prior to its removal. With this technique, we successfully removed the stones in 10 cases. In one, an impacted stone was removed in the X-Ray Department, 6 weeks postoperative and enables cholecystectomy and bile duct stones to be removed in one session with no increase in morbidity or mortality.