Transcystic Stenting and Post-Operative ERCP for CBD Stones at Laparoscopic Cholecystectomy
The clinical presentation and management of common bile duct stones or anticipated common bile duct stones is discussed in Chaps. 6, 7, 8 and 17. Briefly, unless a patient present with cholangitis or possibly persistent jaundice the better outcomes are associated with proceeding directly to a laparoscopic cholecystectomy with operative cholangiogram and either laparoscopic transcystic exploration (Chap. 20) or post-operative ERCP. A recent meta-analysis demonstrated that pre-operative ERCP is associated with a higher morbidity than either post-operative ERCP or intra-operative laparoscopic exploration . Furthermore, intraoperative ERCP has a poorer outcome compared to post-operative ERCP or laparoscopic operative exploration . However, there is no apparent difference between laparoscopic transcystic exploration techniques or post-operative ERCP.
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