World Journal of Laparoscopic Surgery

Register      Login

VOLUME 2 , ISSUE 3 ( September-December, 2009 ) > List of Articles


Practical Considerations for Common Duct Stone Clearance

Dennis L Sta Ana

Citation Information : Ana DL. Practical Considerations for Common Duct Stone Clearance. World J Lap Surg 2009; 2 (3):11-14.

DOI: 10.5005/jp-journals-10007-1029

Published Online: 01-12-2011

Copyright Statement:  Copyright © 2009; The Author(s).


Patients undergoing cholecystectomy have a 10 to 18% chance of common duct stone (CDS) being discovered during the procedure. With the advent of laparoscopy the generally successful open common bile duct exploration for the treatment of common duct stone has been largely replaced by endoscopic means. Lately however, endoscopic clearance is being challenged by a single stage laparoscopic common duct exploration. No clear consensus has been developed to delineate specific practice guidelines for each procedure. Even so, different variables such as patient variables, institutional limitations and technical considerations make the choice of the appropriate procedure a lot more confusing. It is the aim of this article review to find out practical options for the surgeons on the basis of established parameters for safe surgery as well circumstantial parameters that may be variably present in different hospital settings. The search strategy was to review literatures, abstracts, electronic databases, and bibliographies published from year 1999 until 2008 using different medical search engines. Results of this review showed two RCTs (n 378) comparing preoperative endoscopic clearance vs laparoscopic stone clearance and two smaller RCTs (n 166) which compared single stage laparoscopic stone clearance vs delayed endoscopic clearance. There was shorter length of stay in the laparoscopy arm in both studies but stone clearance rate, mortality and morbidity were not significantly different for all studies. Literatures that dealt with circumstantial parameters such as patient variables, institutional limitations and technical expertise, all showed positive significance for these parameters in predicting the success or failure of a procedure for common duct clearance.

PDF Share
  1. Gallstones and laparoscopic cholecystectomy. (National Institutes of Health Consensus Development Panel on Gallstone and Laparoscopic Cholecystectomy). JAMA 1993;269(8):1018-24.
  2. Epidemiology and natural history of common bileduct stones and prediction of disease. Review. Gastrointestinal Endoscopy 2002;56(6 Suppl):S165-69. [MEDLINE: 1247261]
  3. Technical considerations and laparoscopicbile duct exploration: transcystic and choledochotomy. Seminars in Surgery 2000;7(4):262-78.
  4. A simple scoring system for predicting bileduct stones in patients with cholelithiasis. Journal of Gastrointestinal Surgery 2001;5(4):434-37.
  5. Changes in the practice of biliary surgery and ERCPduring the introduction of laparoscopic cholecystectomy to Australia: Their possible significance. Australian and New Zealand Journal of Surgery 1994;64(2):75-80.
  6. Laparoscopic common bile ductexploration and cholecystectomy versus endoscopic stone extractionand laparoscopic cholecystectomy for choledocholithiasis. Aprospective randomized study. Minerva Chir 2002;57:467-74.
  7. EAES multicenter prospective randomized trial comparing two-stage vssingle-stage management of patients with gallstone disease andductal calculi. Surg Endosc 1999;13:952-957.
  8. Postoperative ERCP versus laparoscopic choledochotomy for clearance of selectedbile duct calculi: A randomized trial. Ann Surg 2005;242:188-92.
  9. Laparoscopicexploration of the common bile duct: Lessons learned from 129 consecutive cases. Br J Surg 1995;82:666-68.
  10. Cochrane Database Syst Rev. Apr 2006;19:CD003327.
  11. The role of endoscopic retrograde cholangiopancreatography with laparoscopic cholecystectomy in the management of choledocholithiasis. Am Surg 1994;60:772-76.
  12. Laparoscopic cholecystectomy and common bile duct stones. The utility of planned perioperative endoscopic retrograde cholangiography and sphincterotomy: Experience with 63 patients. Ann Surg 1993;218:61-67.
  13. Laparoscopic cholecystectomy and intraoperative ERCP. Surg Rounds 1996;19:406-12.
  14. An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies. Surgery 1997;122:817-21.
  15. Surg Endosc 12:16-22.
  16. Laparoscopic transcysticcholedochoscopy. Surg 1994;8:310-14.
  17. Laparoscopic choledoscopy: An effective approach to the common bile duct. J Laparoendosc Surg 1992;2:15-21.
  18. Bile duct stones in the laparoscopic era. Is preoperative sphincterotomy necessary? Arch Surg 1995;130:880-85.
  19. How often might a transcystic-ductstone extraction be feasible? Surg Endosc 1998;12:12-15.
  20. Follow-up of 161 unselectedconsecutive patients treated laparoscopically for common bile duct stones. Surg Endosc 1998;12:23-29.
  21. Laparoscopic cholecystectomy in critically ill cardiac patients. Am Surg 1993;59:783.
  22. Management of biliary tract stones in heart transplant patients. Ann Surg 1996;223:L747.
  23. Elective intraoperative intracranial pressure monitoring during laparoscopic cholecystectomy. Arch Surg 1995;130:1011.
  24. Diagnostic laparoscopy increases intracranial pressure. J Trauma 1993;36:815.
  25. Intracranial pressure: Effects of pneumoperitoneumin a large animal model. Surg Endosc 1997;11:376.
  26. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1993;217:233.
  27. Laparoscopic management of acute cholecystitis. Am J Surg 1993;165:508.
  28. Management of choledocholithiasis during pregnancy: A newprotocol in the laparoscopic era. J Laparoendosc. Surg 1995;5:399.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.