Laparoscopic exploration of the common bile duct - Beyond the learning curve

Background: Bile duct clearance at open cholecystectomy had become normal s urgical practice before the introduction of laparoscopic cholecystectomy. H owever, perceived technical difficulties have deterred many surgeons from t reating common bile duct stones at the time of laparoscopic cholecystectomy . This has led to a reliance on preoperative clearance of ducts known to ha ve stones and postoperative clearance of ducts found to have stones at oper ation or those that subsequently develop complications of retained stones. Methods: The authors describe a series of 120 consecutive bile duct explora tions carried out between April 1991 and February 1997 in a series of 1,237 laparoscopic cholecystectomies, Results: Laparoscopic exploration and clearance of the bile ducts was achie ved in 89% of cases in the whole series, and 97% success was attained in th e last 60 cases, which also were associated with a decrease in operating ti me. Conclusions: We believe that for surgeons familiar with open common bile du ct exploration and laparoscopic cholecystectomy, the next logical step is l aparoscopic exploration of the common bile duct at the time of cholecystect omy, which is safe and readily mastered.