Laparoscopic common bile duct exploration: The past, the present, and the future

BACKGROUND: The advent of laparoscopic cholecystectomy (LC) has created a d ilemma for treating patients with known or suspected choledocholithiasis, W ith rapid technologic growth and experience in laparoscopic skills, many su rgeons are now routinely performing laparoscopic common bile duct explorati on (LCBDE) and questioning the wisdom of preoperative endoscopic retrograde cholangiography (ERC) with or without endoscopic sphincterotomy. The purpo se of this article is to review the current literature on the subject of LC BDE and critically evaluate the clinical results of this emerging technolog y. METHODS: Medline and Science Citation Index databases were used to search E nglish language articles published on LCBDE since 1989, RESULTS: Transcystic common bile duct exploration has a better clearance ra te, and carries less morbidity and mortality compared with laparoscopic cho ledochotomy. Compared with two-stage ERCP and LC, one-stage LC and LCBDE se ems to be associated with a shorter hospital stay, a quicker recovery, less expense, and less morbidity and mortality. CONCLUSIONS: LCBDE is a feasible, safe and effective procedure that carries a low morbidity and mortality and will decrease the need for unnecessary E RC in the future for suspected or proved choledocholithiasis, Am J Surg. 20 00;179:309-315, (C) 2000 by Excerpta Medica, Inc.