LAPAROSCOPIC APPROACH TO COMMON DUCT PATHOLOGY

The author reviews his experience with the laparoscopic management of common duct pathology and compares it with the experience of others as reported in the literature. Routine intraoperative cholangiography is advocated. A variety of methods of managing common duct stones laparo scopically is presented. These include balloon-catheter manipulation, fluoroscopically guided basket extraction, and choledochoscopic evalua tion and removal of stones. The accumulated experience indicates that more than 90% of common duct stones can be removed laparoscopically vi a the cystic duct. This approach significantly reduces the need for ei ther preoperative or postoperative endoscopic retrograde cholangiopanc reatography. Although laparoscopic choledochotomy has been employed in a number of cases and can be performed with a high degree of safety a nd efficacy, it is needed only infrequently. This form of management r esults in decreased dependence upon T-tubes, thereby reducing postoper ative morbidity and the length of hospitalization. A rational protocol for the management of common duct pathology is presented.