Managing XXXX in the laparoscopic era.

@entity1 @entity10747 @entity2877
BACKGROUND: Management options for common bile duct stones have explained in the era of laparoscopic cholecystectomy (LC), and selecting the most appropriate method for each @entity1 can be problematic due to the difficulty of predicting accurately which @entity1 have @entity2877 ( @entity2877 ). In order to improve selection of appropriate treatment for @entity2877 , treatment options were analyzed for outcome retrospectively during a 25-month period beginning June 1, 1992. @entity1 AND METHODS: Four hundred four @entity1 underwent LC; 48 (12%) had @entity2877 identified at preoperative @entity10747 ( @entity10747 ) or intraoperative cholangiogram (IOCG). Forty-seven @entity1 were referred for preoperative @entity10747 for suspected @entity2877 , 23 (49%) of whom had proven duct stones and underwent endoscopic sphincterotomy and stone retrieval with an 87% success rate. RESULTS: Of 357 @entity1 scheduled for LC without preoperative @entity10747 , 236 had IOCG, of which 25 (11%) demonstrated @entity2877 . Seven @entity1 had open common bile duct exploration (CBDE). Sixteen @entity1 had postoperative @entity10747 after positive IOCG, 7 (44%) of which were positive for @entity2877 and whose stones were removed with 100% success. Two @entity1 were observed, anticipating spontaneous passage of a small stone. CONCLUSIONS: Preoperative @entity10747 should be applied selectively. For the large majority of @entity1 without preoperative evidence of @entity2877 , we recommend routine IOCG; if @entity2877 is demonstrated, an intraoperative decision can be made to proceed to postoperative @entity10747 in the usual case or to open CBDE for very large or multiple stones. Observation in anticipation of spontaneous passage may be appropriate for small, solitary common duct stones. Continuing advances in laparoscopic CBDE are likely to reduce further the need to rely on @entity10747 in managing @entity2877 .
