[Significance of laparoscopic surgery in the treatment of cholecysto- and choledocholithiasis].
The management of common bile duct stones during laparoscopic cholecystectomy contains some controversy. Our first aim is to detect choledocholithiasis preoperatively making use of a preoperative ultrasound and cholangiogram routinely. Laparoscopic cholecystectomy will follow a preoperative ERCP with endoscopic sphincterotomy and stone extraction in this desirable situation. Cystic duct cholangiography which should become a routine procedure during laparoscopic surgery is feasible in 90-99% and will detect unsuspected common duct stones and iatrogenic bile duct injuries with an accuracy rate of 75.4-90%. This investigation can replace the preoperative cholangiogram in future. A intraoperatively detected common bile duct stone can be managed nowadays by ERCP and sphincterotomy postoperatively or by converting the laparoscopic cholecystectomy into an open common bile duct exploration. Laparoscopic common bile duct exploration is of increasing demand but not yet a routine procedure. If choledocholithiasis will be diagnosed postoperatively, a ERCP with papillotomy will be performed as well. An inquiry among 50 members of the Swiss society of laparoscopic and thoracoscopic surgery (ALTC) with 3718 laparoscopic cholecystectomies pointed out their opinion about the management of common bile duct exploration during laparoscopic surgery in the presented paper.
Chirurgische Klinik, Universitätsspital Zürich.
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Wehrli
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Schlumpf
D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016717:Sphincterotomy, Endoscopic