ABSTRACT
Treatment options of CBD stones include selective pre or postoperative ERCP, open choledochotomy and one-stage laparoscopic clearance. There are several disadvantages to ERCP including the additional invasiveness of endoscopic procedures, moreover large and/or multiple stones, or impacted stones in CBD may be difficult or impossible to retrieve at ERCP even with ES [endoscopic sphincterotomy]. Peroperative real time cholangiography has the advantage of addressing choledocholithiasis with a single procedure LCBDE [Laparoscopic Common Bile Duct Exploration] while leaving the sphincter of Oddi anatomically intact without added morbidity. The choice of treatment between immediate laparoscopic common bile duct exploration, open exploration of CBD and transsphincteric endoscopic retrieval depends on many factors. A prospective study was designed to visualize and examine the biliary ductal system by laparoscopic intra-operative cholangiography [IOC] during laparoscopic cholecystectomy [LC]. The aim was to visualize the ductal anatomy and any anomalies on filling with contrast [to avoid biliary injury], detect any CBD stones and assess the ductal emptying and patency of ampulla of Vater by immediate contrast flow through the papilla into the duodenum. Intraoperative cholangiography was performed for 302 patients underwent LC for chronic calcular cholecystitis [CCC] in Benha University Hospital from Dec. 1999 to Jan 2004. Among 302 patients underwent LC and intraoperative real-time cholangiography, 31 patients [11.3%] were harbouring silent CBD stones managed immediately for CBD clearance. LCBDE was feasible in 23/31 cases who had choledecholithiasis [74.2%], while 8 patients needed conversion to open choledochotomy. 28 patients [9.3%] had preoperative ERCP, endoscopic sphincterotomy [ES], stone retrieval Operative cholangiography during LC proved residual stones in CBD in 2 of them [7.1%] and were treated by open choledochotomy. LCBDE approach is safe, feasible and effective in management of CBD stones and carries low morbidity and mortality. It has the advantage of intraoperative diagnosis and treatment of choledocholithiasis as a [one step] procedure