Laparoscopic approach to common duct pathology.
The author reviews his experience with the laparoscopic management of common duct pathology and compares it with the experience of others as reported in the literature. Routine intraoperative cholangiography is advocated. A variety of methods of managing common duct stones laparoscopically is presented. These include balloon-catheter manipulation, fluoroscopically guided basket extraction, and choledochoscopic evaluation and removal of stones. The accumulated experience indicates that more than 90% of common duct stones can be removed laparoscopically via the cystic duct. This approach significantly reduces the need for either preoperative or postoperative endoscopic retrograde cholangiopancreatography. Although laparoscopic choledochotomy has been employed in a number of cases and can be performed with a high degree of safety and efficacy, it is needed only infrequently. This form of management results in decreased dependence upon T-tubes, thereby reducing postoperative morbidity and the length of hospitalization. A rational protocol for the management of common duct pathology is presented.
Petelin
J B
JB
Department of Surgery, University of Kansas School of Medicine, Shawnee Mission 66204.
D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002985:Clinical Protocols; D003135:Common Bile Duct / Q000601:surgery; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D011183:Postoperative Complications; D014481:United States