Surgery for common bile duct stones—a lost surgical skill; still worthwhile in the minimally invasive century?

Abstract

Surgery may reclaim this lost ground by offering an excellent and safe therapeutic option for many of the symptomatic CBDS.

Single-session laparoscopic cholecystectomy and ERCP: a valid option for the management of choledocholithiasis

“…[23][24][25] However, although open CBD exploration was an important tool in the armamentarium of treatment of choledocholithiasis before the introduction of ERCP, laparoscopic CBD exploration remains somewhat limited at this point to those with specialized hepatobiliary or advanced laparoscopic training, and arguably, appropriate expertise is not sufficiently widespread. [26][27][28][29] Laparoscopic CBD exploration is not a first-line technique of choice at our institution, and as a recent study by Darrien et al 30 demonstrates, there can still be a relatively high rate of technical failure with even more simplistic variations to this approach, particularly when this is being used selectively rather than as a routine treatment. 30 In our series, endoscopic CBD cannulation and clearance rates were remarkably high and morbidity of ERCP was low, reflecting the benefits of a high-volume center with a significant amount of technical expertise.…”

Intraoperative ERCP for management of cholecystocholedocholithiasis

“…Moreover, because the expertise in surgical bile duct exploration is diminishing significantly, many surgeons remain fearful of conducting LCBDE [26]; therefore, the treatment strategy is often led by the local presence of professional expertise and resources, rather than by a real superiority of one strategy over another [27]. The preferred option for Open CBD exploration (n = 2)…”

Primary Closure Versus Biliary Drainage After Laparoscopic Choledocotomy

“…It also makes the simultaneous treatment of this condition possible, in association with cholecystectomy. 7 If stone extraction is performed by the transcholedochal approach, the surgeon has 2 main options for choledocotomy management: primary closure (PC), or closure with biliary drainage (BD) (T-tube drain, transcystic drain). 8 In recent years, many authors have reconsidered the use of BD and proposed PC of the choledocotomy as an alternative.…”