Laparoscopic CBD Exploration

Common bile duct (CBD) stones are identified in 10 to 15 percent of patients undergoing surgery for symptomatic cholelithiasis. CBD stones require extraction for management of symptoms and to prevent complications such as acute suppurative cholangitis, obstructive jaundice, hepatic abscess, and acute pancreatitis.

In the past, CBD stones were diagnosed with intraoperative cholangiography and treated with open CBD exploration. Advances in preoperative imaging technology such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound, as well as the development of endoscopic retrograde cholangiopancreatography (ERCP) and minimally invasive surgical techniques, have allowed for less invasive and more accurate methods of identifying and treating CBD stones.

This topic will review laparoscopic and open CBD exploration. The diagnosis and the endoscopic treatment of choledocholithiasis (ie, ERCP) are discussed elsewhere. (See "Choledocholithiasis: Clinical manifestations, diagnosis, and management" and "Endoscopic management of bile duct stones: Standard techniques and mechanical lithotripsy").