Laparoscopic management of Calcular Obstructive Jaundice

Abstract

In the era of open cholecystectomy, open common bile duct exploration was the procedure of choice for CBD stones. However, with laparoscopic cholecystectomy becoming the gold standard for cholelithiasis, the treatment for CBD stone has changed and various options are now available. These include Endoscopic Retrograde Cholangiopancreatography, laparoscopic CBD exploration or open CBD exploration. Laparoscopic CBD exploration has all the advantages of minimal access and is also most cost effective compared to the other options. However, advanced surgical skills are required for the performance of the procedure. Laparoscopic Surgery for common bile duct stones was first described in 1991, Petelin . The surgical technique has evolved since then and several studies have concluded that Laparoscopic common bile duct exploration procedures are superior to sequential endolaparoscopic treatment in terms of both clinical and economical outcomes. (Savita and Bhartia, 2010)

Prior to the development of minimally invasive surgery, when the surgical approach to CBD stones consisted of choledocholithotomy by open surgery, there was considerable morbidity (11–14 %) and even mortality(0.6–1 %) . With the advent of endoscopic and laparoscopic techniques, CBD stones were removed preoperatively by endoscopy, which was followed by LC . With refinements in laparoscopic techniques and experience many centers have started performing laparoscopic CBD exploration with acceptable results and complications. (Sharma et al., 2012)

Gallstones and common bile duct calculi are found to be associated in 8%-20% of patients, leading to possible life-threatening complications, such as acute biliary pancreatitis, jaundice and cholangitis. Although some authors have advocated for a “wait and see” policy for asymptomatic gallbladder stones, almost none could propose the same approach if CBDS are detected as well. (Bencini et al., 2014)

Obstructive jaundice is a medical emergency. Local guidelines should be in place and widely publicized to facilitate timely investigation and management and avoid complications. (Briggs and Peterson, 2007) Laparoscopic exploration of the common bile duct is becoming