Management of choledocholithiasis found during laparoscopic cholecystectomy: A strategy based on the use of postoperative endoscopic retrograde cholangiography and sphincterotomy

Background. Several strategies have been proposed for the diagnosis and man agement of common bile duct stones in candidates for laparoscopic cholecyst ectomy. Methods. Clinical characteristics, treatment, and outcome of five p atients in whom CBDS were demonstrated by intraoperative cholangiography du ring a laparoscopic cholecystectomy were analyzed. All patients were treate d by endoscopic sphincterotomy Post-treatment outcome was emphasized. Resul ts. Mean. age of the patients was 55 years. Four were female and one male. Preoperative liver function tests were within normal range in all patients. Duct stones of a mean size of 0.8 cm were found in the lower third of the biliary tree. Four were retrieved by endoscopic sphincteroplasty using a Do rmia basket and in one patient after an unsuccessful endoscopic attempt, an open choledochoduodenostomy was performed. There were no post-treatment co mplications. At a mean follow-up Of 2 years no evidence of recurrent common bile duct obstruction has been found in any patient. Conclusions. This sma ll series supports the use of postoperative endoscopic retrograde cholangio graphy and sphincteroplasty in patients with unsuspected common bile duct s tones found during laparoscopic cholecystectomy. Retrieval of the stones im mediately after surgery at the operative room is recommended.