Laparoscopic cholecystectomy and choledocholithiasis.

Between November 1990 and March 1991, five patients with cholelithiasis and associated choledocholithiasis were treated by laparoscopic cholecystectomy and common-bile-duct exploration (CBDE). Three patients had a successful CBDE, but in two common-bile-duct stones had to be extracted surgically. Two patients had formal laparoscopic CBDE, and three patients had CBDE performed through the cystic duct. All patients recovered from surgery without complication. Laparoscopic CBDE is difficult to perform because of lack of adequate instrumentation and limited experience. Although the authors do not recommend that this procedure be performed widely at present, they believe it will eventually replace many open CBDEs. The authors review the pertinent literature and evaluate diagnostic means for preoperative and peroperative detection of choledocholithiasis. They discuss the alternatives to laparoscopic CBDE, their advantages and disadvantages. Finally, they summarize their own policy with respect to laparoscopic CBDE.