title: Passage of Gallstones Into Common Bile Duct During Laparoscopic Cholecystectomy: Is It the Surgeon's Responsibility?
abstract: OBJECTIVE
  Gallstones patients without preoperative history of jaundice, deranged liver function tests, or dilated bile ducts (BD) are unlikely to have BD stones. However, some of these patients in our series underwent endoscopic stone(s) removal after laparoscopic cholecystectomy (LC). We aim to find the incidence, possible intraoperative risk factors, and if the Surgeon can be blamed for this event.
  
  
  METHODS
  We studied LC cases over 12-year period at our university hospital and identified patients who did not have preoperative risk factors for BD stones but developed postoperative jaundice and/or persistent abdominal pain.
  
  
  RESULTS
  Only 16 (0.7%) of 2390 LC met the inclusion criteria. In 5/16 patients, cystic duct (CD) stones were felt Intraoperatively and likely passed into BD during surgery. After surgery, 14/16 patients underwent endoscopic stone(s) removal.
  
  
  CONCLUSIONS
  If CD stone(s) are encountered during LC, we suggest that careful attention should be paid to make sure that patient does not develop complications from possible BD stone(s). Technical precautions during LC (ie, early CD clipping, avoiding excessive manipulation, and crushing the stones) are recommended.
authors.affiliation: Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Bani Hani
authors.forename: Abdel Rahman
authors.initials: AR
authors.lastname: Al Manasra
authors.forename: Haitham
authors.initials: H
authors.lastname: Qandeel
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002983:Clinical Competence / Q000592:standards*; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D041781:Jaundice, Obstructive / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012941:Social Responsibility; D066231:Surgeons / Q000592:standards*