title: Laparoscopic treatment for unsuspected common bile duct stones by transcystic sphincter of Oddi pneumatic balloon dilation and pressure-washing technique.
abstract: BACKGROUND
  Unsuspected common bile duct stones (CBDS) are found in 4-5 % of patients with cholelithiasis. The optimal strategy for the treatment of asymptomatic CBDS, diagnosed during laparoscopic cholecystectomy (LC), is not yet well established. A one-stage solution is preferable to solve the CBDS during the LC and to avoid the exposure of patients to the risks of a second procedure, such as complications or failure.
  
  
  METHODS
  We attempted to remove CBDS by transcystic sphincter of Oddi pneumatic balloon dilation and common bile duct pressure-washing in all cases of intraoperative identification of CBDS since September 2008.
  
  
  RESULTS
  In 29 cases, unsuspected CBDS was identified by intraoperative cholangiography; in 28 cases a single stone with a mean diameter of 4.3 mm (range = 3-6) was detected and in one case three 5-8-mm-diameter stones were identified. Clearance of the common bile duct was obtained in 27 cases (96 %), with a mean operative time of 54 min (range = 36-90) and mean length of hospital stay of 2.5 days.
  
  
  CONCLUSIONS
  Treatment of unsuspected CBDS detected by intraoperative cholangiography during LC with this original technique was safe and effective and a viable alternative of the transcystic endoscopic approach.
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Masoni
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pietropaolo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Onorato
authors.forename: Massimo
authors.initials: M
authors.lastname: Meucci
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
mesh_terms: D000328:Adult; D000368:Aged; D042883:Choledocholithiasis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery*; D004106:Dilatation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009803:Sphincter of Oddi / Q000601:surgery*; D016717:Sphincterotomy, Endoscopic; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome