Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy

Table 1 Preoperative diagnosis of 27 cases

Preoperative diagnosis	NO. of patients
Acute cholecystitis with multiple gallstones	3
Chronic cholecystitis with multiple gallstones	15
Acute cholecystitis with multiple gallstones and CBDs	3
Chronic cholecystitis with multiple gallstones and CBDs	6

Table 2 Alternatives of management of coexisting gallbladder and CBD stones

Methods	Shortcomings
Convert to open choledochostomy	loss of all advantages of minimally invasive surgery
Laparoscopic transcystic duct choledochoscopy	limited by cystic duct anatomy and risk associated with cystic duct dilation
Laparoscopic choledochostomy	Installation of T-tube and high technical demand
Preoperative ERCP and EST	hard to precisely predict preoperative CBD stones; if failed, subsequent operation should be considered
Postoperative ERCP and EST	If failed, another operation should be performed