Management of choledocholithiasis in the time of laparoscopic cholecystectomy

The best way to detect and manage common duct stones in conjunction with laparoscopic Cholecystectomy is not agreed upon at the present time. Our experience with Choledocholithiasis in a consecutive series of 1,123 cholecystectomies (94% by laparoscopy) has been reviewed. Suspected duct stones were investigated preoperatively or postoperatively by endoscopic retrograde cholangiography (ERC), and if necessary, duct clearance was attempted by endoscopic sphincterotomy (ES). No attempt was made to identify Choledocholithiasis intraoperatively. Endoscopic retrograde cholangiography was performed in 11% of patients, and 32% of these required ES. The complication rate of ERC and ES was 8%, without mortality. Two patients required a second operation for missed Choledocholithiasis, for a reoperation rate of 0.2%. We believe that primary or secondary open surgery is only occasionally necessary for the management of Choledocholithiasis. Preoperative ERC and ES for suspected duct stones, with the same strategy employed as a salvage for stones presenting after Cholecystectomy, was safe and efficient.