Management of Bile Duct Stones in the Era of Laparoscopic Cholecystectomy

The development of laparoscopic cholecystectomy has transformed many aspects of gallstone disease management, particularly the care of patients with known or suspected bile duct stones. New obstacles to operative access to the bile duct have stressed the importance of accurate clinical prediction and detection of bile duct stones and led to increased reliance on nonsurgical approaches, especially pre- or postoperative endoscopic retrograde cholangiopancreatography and sphincterotomy, as well as spurring the development of new techniques such as laparoscopic common bile duct exploration. This work reviews the key features and rational usage of the endoscopic, laparoscopic and open surgical procedures, as well as other adjunct techniques, employed in the treatment of bile duct stones, emphasizing current options in the approach to this problem in the perilaparoscopic cholecystectomy setting. Management of bile duct stones in other special clinical circumstances and the potential future role of emerging technologies are also discussed.