COMMON BILE-DUCT EXPLORATION - THE PLACE OF LAPAROSCOPIC CHOLEDOCHOTOMY

Since laparoscopic cholecystectomy was introduced, the treatment of ch oledocholithiasis has been modified. Preoperative endoscopic retrograd e cholangiopancreatography (ERCP) has been performed selectively in el derly patients and in those with a strong suspicion of biliary duct st ones (jaundice, demonstrated at ultrasound). Intraoperative discovery of common duct stones at cystic duct cholangiography signifies that th ey must be removed intraoperatively [or postoperatively by ERPC and en doscopic sphincterotomy (ES)]. As ES has a failure rate of 3-23%, lapa roscopic common duct exploration emerges as the treatment of choice. S ince November 1990, we have performed 59 laparoscopic common bile duct explorations. In our experience, the transcystic technique (18 patien ts) with choledochoscopy appears easier to perform than with fluorosco py without choledochoscopy. Since, during our early experience, we enc ountered some difficulty with the transcystic technique, we elected to evaluate common duct exploration through a choledochotomy (41 patient s). The main advantage of this technique is that it provides complete access to the ductal system without damage to the papilla. This proced ure seems more difficult to perform than the transcystic technique and can be used when there are contraindications to the latter.