Laparoscopic approaches to the common bile duct stone: transcystic bile duct exploration, choledochotomy and stone fragmentation

摘要: It has been illustrated that a convergence of new technologies, including advanced laparoscopic techniques, flexible video endoscopy, coaxial balloon dilators and biliary lithotripsy, allowed the modern surgeon to address pressing issue: how deal with choledocholithiasis. A variety techniques methods have described; each their advocates, philosophical advantages potential drawbacks. The definitive decision as which technique is best awaits results future prospective studies. Until then, three outlined will allow majority surgeons extend minimally invasive surgery patients There no doubt this desirable. These procedures, however, are not without failure rate complications, they remain technically demanding. Increased education training needed further improvement existing technology demanded. This includes improved fibreoptic choledochoscopes better optics, more flexibility larger working channels; stone baskets mechanical graspers, safer effective lithotriptors. Other questions unanswered, such relative absolute contraindications performing common duct explorations. Can multiple stones or very small ducts be safely handled using these methods? Is there size safe leave behind, antegrade treating distal stenosis? interest in avoiding placement T-tubes for drainage also needs close scrutiny. All need well-constructed studies answer them; but meantime, exploration undoubtedly here stay, approach an old problem inducing question many traditionally held dicta, can long run only patients' interest.