Common Bile Duct Exploration

Abstract

Treatment for common bile duct stones (CBDS) has been divided roughly into two different procedures, two-step and single step methods. In the two-step method, LC is performed after endoscopic treatment. The single-step method includes open or laparoscopic surgery in which common bile duct stones are removed during surgery. Single-step laparoscopic surgery, namely laparoscopic common bile duct exploration (LCBDE), is preferred because of the simplicity of treatment. Needlescopic LCBDE has two benefits. One is completion of treatment for CBDS during one time laparoscopic surgery, and the other is less invasiveness to the abdominal wall and resulting cosmetic improvement.

There are two kinds of approaches in LCBDE, according to the route of exploration: trans-cystic duct exploration (LTCE) and trans-choledochal exploration (LCHE).

Although there are limitations to the indication for needlescopic LTCE, it is feasible and should be the first line of treatment for CBDS. The benefits of this approach include not only the fact that it is non-invasive to the sphincter and does not injure the CBD wall, but also that it can offer a good cosmetic result. With LCHE as a redeeming approach, LCBDE with needle forceps is also feasible and offers good clinical outcomes in treatment for CBDS.