RT Book, Section
A1 Hunter, John G.
A1 Spight, Donn H.
A1 Sandone, Corinne
A1 Fairman, Jennifer E.
SR Print(0)
ID 1162530881
T1 Common Bile Duct Exploration
T2 Atlas of Minimally Invasive Surgical Operations
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071449052
LK accesssurgery.mhmedical.com/content.aspx?aid=1162530881
RD 2024/09/10
AB Laparoscopic  common  bile  duct  (CBD)  exploration  (LCBDE)  is  indicated  for  all  patients  with  known  CBD  stones  at  the  time  of  laparoscopic  cholecystectomy,  but  is  most  commonly  used  when  an  intraoperative  cholangiogram  or  ultrasound  exam  demonstrates  one  or  more  filling  defects  in  the  CBD,  presumed  to  be  CBD  stones.  Following  cholecystectomy,  most  CBD  stones  are  addressed  with  endoscopic  retrograde  cholangiography  and  endoscopic  sphincterotomy  (ERC/ES)  rather  than  LCBDE.  Additionally,  in  the  presence  of  acute  cholangitis  or  acute  pancreatitis  from  choledocholithiasis,  ERC/ES  has  proven  to  be  a  safer  strategy  that  open  CBDE.  Although  no  studies  have  randomized  patients  with  acute  cholangitis  to  LCBDE  or  ERC/ES,  the  benefits  of  urgent  bile  duct  decompression  can  usually  be  achieved  with  an  ERC/ES,  followed  by  laparoscopic  cholecystectomy  (if  not  already  performed)  at  a  later  date,  when  the  acute  illness  has  resolved.