LAPAROSCOPIC TREATMENT OF KNOWN CHOLEDOCHOLITHIASIS

Background: Occasionally patients represent to the surgeon with known common duct stones. These will frequently have been detected by imagin g modalities: ultrasound, computed tomography (CT) scans, transhepatic cholangiogram (THC) or IV cholangiography. Occasionally there are sto nes that had failed attempts at endoscopic retrieval (ERCP). Methods: A retrospective analysis of a prospectively gathered database of 77 la paroscopic common bile duct explorations was done to assess the incide nce, treatments and outcomes of patients who had known common duct sto nes (CDS) before surgery. Results: Eighteen patients (23%) were identi fied as having a preoperative diagnosis of CDS. All underwent a laparo scopic common bile duct exploration. This exploration was successful i n all cases. Outcomes were good with a 4% complication rate and one ca se of retained common duct stones (4%). Conclusions: Before laparoscop ic cholecystectomy, known choledocholithiasis was considered a surgica l disease except in cases of acute cholangitis or the very morbidly il l. The ability to perform cholecystectomy laparoscopically made many p ractitioners avoid open common duct exploration and, instead, rely on ERCP as primary treatment for known or suspected common duct stones. A s techniques of laparoscopic common duct exploration improve, the abil ity to deal with common duct pathology surgically has increased, offer ing new options for treatment of this patient population. We present o ur experience with 18 patients who presented with known choledocholith iasis and were treated laparoscopically with good results.