Treatment of common bile duct stones discovered during cholecystectomy.
BACKGROUND
Several techniques of laparoscopic bile duct exploration and intraoperative endoscopic sphincterotomy (ES) have been developed to treat patients with common bile duct (CBD) stones in one session and avoid the complications of ES. With all these options available, very few randomized controlled trials (RCTs) have been undertaken. This review analyzes those studies.


METHODS
We searched PubMed. Four RCTs and a Cochran Database Systematic Review were found.


RESULTS
Two RCTs compared preoperative ES and laparoscopic CBD exploration (E) for known CBD stones. Laparoscopic CBDE had shorter length of hospitalization. Two RCTs compared immediate and delayed treatment and found that length of stay was less with laparoscopic CBDE, but clearance rates and morbidity/mortality were similar.


CONCLUSIONS
Studies suggest that CBD stones discovered at the time of cholecystectomy are best treated during the same operation. The transcystic approach is safest if applicable. Individual surgeons must be aware of their own capabilities and those of the available endoscopists and perform the safest technique.
Phillips
Edward H
EH
Department of Surgery, Cedars-Sinai Medical Center, 8635 W. Third St., Suite 795W, Los Angeles, CA 90048, USA. edward.phillips@cshs.org
Toouli
James
J
Pitt
Henry A
HA
Soper
Nathaniel J
NJ
D002763:Cholecystectomy; D042882:Gallstones / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D016717:Sphincterotomy, Endoscopic