MANAGEMENT OF CHOLEDOCHOLITHIASIS ENCOUNTERED DURING LAPAROSCOPIC CHOLECYSTECTOMY

To evaluate the prevailing methods of management and assess the safety of laparoscopic treatment of choledocholithiasis, a retrospective rev iew of all common bile duct explorations (CEDE) initiated during lapar oscopic cholecystectomy at the Medical College of Georgia was performe d. From December 1990 until December 1994, 604 laparoscopic cholecyste ctomies were performed. In 28 of these patients (26 female, 2 male) wi th an age range of 17 to 60 years, CEDE was initiated; 21 were perform ed laparoscopically, and 7 were converted to open CEDE. The procedure was successful in completely clearing the duct of stones in 24 of 28 c ases, (17 laparoscopic, 7 open). Postoperative endoscopic retrograde c holangiopancreatography was successfully employed in three of the case s of retained stones, and in the fourth, the stone was felt to be smal l enough to pass without further intervention. Biliary balloon cathete rs were successfully used to clear the duct in 8 of 17 laparoscopic CB DEs, and a laparoscopic choledochoscope introduced through the cystic duct was used in 7 cases; both were used in 2 eases. The open CBDEs we re performed in standard fashion utilizing balloon catheters and chole dochoscopy. The only operative complications were the four above-menti oned cases of retained stones. In summary, choledocholithiasis encount ered during the course of laparoscopic cholecystectomy can frequently be managed with a laparoscopic CEDE.