MANAGEMENT OF BILE-DUCT STONES IN THE ERA OF LAPAROSCOPIC CHOLECYSTECTOMY

The development of laparoscopic cholecystectomy has transformed many a spects of gallstone disease management, particularly the care of patie nts with known or suspected bile duct stones. New obstacles to operati ve access to the bile duct have stressed the importance of accurate cl inical prediction and detection of bile duct stones and led to increas ed reliance on nonsurgical approaches, especially pre-or postoperative endoscopic retrograde cholangiopancreatography and sphincterotomy, as well as spurring the development of new techniques such as laparoscop ic common bile duct exploration. This work reviews the key features an d rational usage of the endoscopic, laparoscopic and open surgical pro cedures, as well as other adjunct techniques, employed in the treatmen t of bile duct stones, emphasizing current options in the approach to this problem in the perilaparoscopic cholecystectomy setting. Manageme nt of bile duct stones in other special clinical circumstances and the potential future role of emerging technologies are also discussed.