STATUS AND TECHNIQUE OF LAPAROSCOPIC COMM ON BILE-DUCT EXPLORATION INCASES OF CHOLEDOCHOLITHIASIS

Despite a large scale indication to ERCP, 5 % of unsuspected stones ar e shown by principally intraoperative cholangiography in our patients. Praeoperative diagnostic makes it possible to select the individual o ptimal therapy for each patient, the possibility of saving the Papilla vateri gives the large scale indication to laparoscopic common bile d uct exploration. Also suspected stones gets a one-time cure therapy by complete laparoscopic operation. After balloon-dilatation of cysticus duct to 6 mm, the laparoscopic choledochoscopy is possible through th e cysticus duct. Little stones are flushed into the duodenum or extrac ted by Segure-basket through the cysticus duct. Big stones needs a Las er or electrohydraulic lithotripsy, the stonefragments can be flushed into the duodenum or aspirated through the cysticus duct. Multiple big or proximal incarcerated stones gives the indication for laparoscopic choledochotomy. Effective extraction is possible by big Segura-basket , residual stones are taken out under choledochoscopic control by litt le Segura-basket. Incarcerated stones needs the lithotripsy. Microdrai nage of the common bile duct and only in special indication the T-tube saves the gall-flow to restitution of papilla function, the common bi le duct is closed by running suture in Lahodny-technique. After the re gular postoperative cholangiography on third day after operation, the microdrainage can be taken out. In 96 % of all Laparoscopic cholecyste ctomies the intraoperative cholangiography was successful. Only 3 of 1 03 patients needs a postoperative EPT because of residual fragments af ter trans cystic duct exploration. 8 laparoscopic choledochotomies sho ws the successness of endoscopic the postoperative complications can b e the same then in conventional operation.