Recent approach for common bile duct stone.

One hundred and thirty-nine patients underwent cholecystectomy from 1992 through 1994. Twenty-seven patients demonstrated preoperative risk factors for common bile duct (CBD) stones and underwent endoscopic retrograde cholangiopancreatography (ERCP). ERCPs were successful in 25 (92.6%) patients and there were two failures, due to pyloric obstruction and duodenal diverticulum. Of 25 patients suspected of harboring CBD stones, 48 per cent had bile duct stones on preoperative ERCP. In contrast, 3 of 112 patients (2.7%) thought not to have stones indeed had choledocholithiasis. Laparoscopic cholecystectomies (LC) were performed on 19 (76%) of 25 patients. Of these 19, 13 (68%) had negative ERCP, 5 (26.3%) had stones removed by endoscopic sphincterotomy (ES), and only one was accomplished with laparoscopic choledochoduodenostomy. Open exploration of CBD was performed on 3 patients who had complex CBD stones and bilio-enteric bypasses in 2 patients who had multiple impacted stones in the left main duct. Overall, three endoscopic failures (2 ERCPs and 1 ES) were managed by open biliary surgery. We suggest that patients with complex CBD stones who are not successful in stone extraction via ES should undergo open CBD surgery. LC following successful ES has been accepted as the gold standard for the treatment of simple CBD stones.