Laparoscopic management of bile duct stones.

Although it may seem that laparoscopic cholecystectomy has revolutionized the way we approach the patient with stones in the gallbladder and bile ducts, only a few rules have really changed. Fluoroscopic cholangiography, a requirement for radiologists and gastroenterologists performing percutaneous transhepatic cholangiography and ERCP, is slowly finding its way into the operating room. No longer is a "palpable stone" a common indication for common bile duct exploration. Most importantly, it is not necessary to make an incision into the bile duct to remove the majority of bile duct stones. The transcystic approach will clear the duct in 85% to 90% of all patients, sparing them extra hospitalization, a T-tube, and the risk of creating a bile duct stricture during sutured closure of the choledochotomy.