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Abstract
An analysis of the results of our present study and a review of the
literature shows that laparoscopic exploration of the common bile duct is
a feasible, safe and effective approach that carries a low morbidity and
mortality for management of choledocholithiasis. The development of
instrumentations and techniques increased the interest in learning these
new laparoscopic skills and allowed the procedure to be performed
safely. The weight of the evidence also suggested a revised role of
endoscopic retrograde cholangiopancreatography (ERCP), which has
been questioned because of its cost, risk of complications and
effectiveness. Many surgeons are still unfamiliar with these techniques
and the benefits of the one-session approach. However, we estimate that
LCBDE will become widely used in patients with choledocholithiasis,
especially with appropriate training and motivation.
In our present study we found that the IOC success rate was up to
100%. Laparoscopic cholecystectomy with routine application of IOC
can be performed with safety and with no significant increase in operative
time, costs and incidence of retained stones. Routine IOC also permitted
us to avoid unnecessary preoperative ERCP in patients with suspected
common bile duct stones as reflected in our practice.
There are two different methods of LCBDE:
A. The transcystic approach (TCE).
B. The choledochotomy approach (Transductal approach) (CBDE).