Management of choledocholithiasis found during laparoscopic cholecystectomy: a strategy based on the use of postoperative endoscopic retrograde cholangiography and sphincterotomy.
BACKGROUND
Several strategies have been proposed for the diagnosis and management of common bile duct stones in candidates for laparoscopic cholecystectomy.


METHODS
Clinical characteristics, treatment, and outcome of five patients in whom CBDS were demonstrated by intraoperative cholangiography during a laparoscopic cholecystectomy were analyzed. All patients were treated by endoscopic sphincterotomy. Post-treatment outcome was emphasized.


RESULTS
Mean age of the patients was 55 years. Four were female and one male. Preoperative liver function tests were within normal range in all patients. Duct stones of a mean size of 0.8 cm were found in the lower third of the biliary tree. Four were retrieved by endoscopic sphincteroplasty using a Dormia basket and in one patient after an unsuccessful endoscopic attempt, an open choledochoduodenostomy was performed. There were no post-treatment complications. At a mean follow-up of 2 years no evidence of recurrent common bile duct obstruction has been found in any patient.


CONCLUSIONS
This small series supports the use of postoperative endoscopic retrograde cholangiography and sphincteroplasty in patients with unsuspected common bile duct stones found during laparoscopic cholecystectomy. Retrieval of the stones immediately after surgery at the operative room is recommended.
Ganci-Cerrud
G
G
Departments of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, D. F.
Chan
C
C
Bobadilla
J
J
Elizondo
J
J
Valdovinos
M A
MA
Herrera
M F
MF
D000328:Adult; D000368:Aged; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D002768:Choledochostomy; D002769:Cholelithiasis / Q000150:complications; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009803:Sphincter of Oddi / Q000601:surgery*; D016896:Treatment Outcome