Published online Nov 7, 2014. doi: 10.3748/wjg.v20.i41.15144
Revised: March 6, 2014
Accepted: June 26, 2014
Published online: November 7, 2014
Up to 18% of patients submitted to cholecystectomy had concomitant common bile duct stones. To avoid serious complications, these stones should be removed. There is no consensus about the ideal management strategy for such patients. Traditionally, open surgery was offered but with the advent of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy (LC) minimally invasive approach had nearly replaced laparotomy because of its well-known advantages. Minimally invasive approach could be done in either two-session (preoperative ERCP followed by LC or LC followed by postoperative ERCP) or single-session (laparoscopic common bile duct exploration or LC with intraoperative ERCP). Most recent studies have found that both options are equivalent regarding safety and efficacy but the single-session approach is associated with shorter hospital stay, fewer procedures per patient, and less cost. Consequently, single-session option should be offered to patients with cholecysto-choledocholithiaisis provided that local resources and expertise do exist. However, the management strategy should be tailored according to many variables, such as available resources, experience, patient characteristics, clinical presentations, and surgical pathology.
Core tip: This paper discusses minimally invasive options for management of patients with concomitant gallbladder stones and common bile duct stones with special focus on the technique, benefits, controversial issues, and difficulties of single session approach. Additionally, we investigate recent comparative studies between single-session and two-session approach.