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Surgical Innovation
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Prospective Trials in Laparoscopic Bile Duct Exploration

Bertrand Millat

Department of Visceral Surgery "A", University Hospital Saint Eloi, Montpellier, France, Department of Digestive Surgery, Centre Hopsitalier Intercommunal, Poisg, France

Frederic Borie

Department of Visceral Surgery "A", University Hospital Saint Eloi, Montpellier, France, Department of Digestive Surgery, Centre Hopsitalier Intercommunal, Poisg, France

Abe Fingerhut

Department of Visceral Surgery "A", University Hospital Saint Eloi, Montpellier, France, Department of Digestive Surgery, Centre Hopsitalier Intercommunal, Poisg, France

Laparoscopic exploration of the common bile duct (CBD) is performed either for the diagnosis or the treatment of CBD stones. Laparoscopic intraoperative cholangiography (IOC) versus ultrasonography (LUS) and laparoscopic versus endoscopic extraction of CBD stones were compared through a review of the prospective, comparative studies, randomized or not, evaluating these different techniques. Cystic duct cholangiography and fluoroscopic imaging are the standards for IOC. The potential protective effect of IOC regarding the risk or severity of CBD injuries might be the major argument for a routine use of laparoscopic IOC. Most if not all the purported advantages of LUS versus IOC for the diagnosis of CBD stones remain to be proven. Laparoscopic intraoperative diagnosis of CBD stones by cholangiography or ultrasonography followed by the laparoscopic extraction or, in case of failure, by postoperative endoscopic sphincterotomy, might represent the future for the diagnosis and treatment of CBD stones. Copyright © 2000 by W.B. Saunders Company.

Key Words: Laparoscopy • common bile duct stones • intraoperative cholangiography • laparoscopic ultrasonography • treatment.

Surgical Innovation, Vol. 7, No. 4, 279-287 (2000)
DOI: 10.1177/155335060000700407
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