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World J Gastrointest Surg. May 27, 2016; 8(5): 376-381
Published online May 27, 2016. doi: 10.4240/wjgs.v8.i5.376
Role of laparoscopic common bile duct exploration in the management of choledocholithiasis
Nikhil Gupta
Nikhil Gupta, Department of Surgery, PGIMER Dr RML Hospital, Delhi 110001, India
Author contributions: Gupta N solely contributed to this paper.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Nikhil Gupta, MS, MRCSEd, FAIS, FMAS, FIAGES, MNAMS, Assistant Professor, Department of Surgery, PGIMER Dr RML Hospital, B-406 Panchsheel Apartments, Plot-9, Sector-10, Dwarka, Delhi 110001, India. nikhil_ms26@yahoo.co.in
Telephone: +91-011-45526090 Fax: +91-011-45526090
Received: July 29, 2015
Peer-review started: September 1, 2015
First decision: December 7, 2015
Revised: February 5, 2016
Accepted: February 23, 2016
Article in press: February 24, 2016
Published online: May 27, 2016
Abstract

Surgical fraternity has not yet arrived at any consensus for adequate treatment of choledocholithiasis. Sequential treatment in the form of pre-operative endoscopic retrograde cholangio-pancreatography followed by laparoscopic cholecystectomy (LC) is considered as optimal treatment till date. With refinements in technique and expertise in field of minimal access surgery, many centres in the world have started offering one stage management of choledocholithiasis by LC with laparoscopic common bile duct exploration (LCBDE). Various modalities have been tried for entering into concurrent common bile duct (CBD) [transcystic (TC) vs transcholedochal (TD)], for confirming stone clearance (intraoperative cholangiogram vs choledochoscopy), and for closure of choledochotomy (T-tube vs biliary stent vs primary closure) during LCBDE. Both TC and TD approaches are safe and effective. TD stone extraction is involved with an increased risk of bile leaks and requires more expertise in intra-corporeal suturing and choledochoscopy. Choice depends on number of stones, size of stone, diameter of cystic duct and CBD. This review article was undertaken to evaluate the role of LCBDE for the management of choledocholithiasis.

Keywords: Laparoscopic common bile duct exploration, Choledochoscopy, Cholangiogram, Choledocholithiasis, Primary closure

Core tip: Various treatment modalities are available for management of choledocholithiasis. Laparoscopic common bile duct exploration offers one stage management of cholelithiasis with choledocholithiasis. This review article was undertaken to evaluate this technique and its various aspects.