Historical Perspective on the Treatment of Choledocholithiasis: Lessons Learned and Techniques Prior to the Laparoscopic Era
Current Understanding of Choledocholithiasis- Clinical Presentation and Pre-operative Evaluation
Preoperative Decision-making Algorithm
Intraoperative Ultrasound- Technique, Results, Pearls/Pitfalls, Rationale, and Benefits of Routine Use
Intraoperative Cholangiography- Technique, Results, Pearls/Pitfalls, Rationale, and Benefits of Routine Use
Laparoscopic Trans-cystic Exploration (Deciding who to Approach, Contraindications, Techniques- Cannulation, Dilation, Flouro-guided v. Choledochoscopy, Results, Complications, and Their Management.- Laparoscopic transcholedochal exploration (deciding who to approach, contraindications, technique of choledochotomy, instruments – catheters, scopes, etc., closure – primary v. t-tube v. internal drainage, results, complications and their management).- Stone fragmentation technologies and the approach to impacted stones (laser, mechanical lithotripsy, shock-wave, pneumatic and ultrasonic lithotriptors).- Adjuncts to common bile duct exploration (stents, drains, balloon dilation, antegrade sphincterotomy).- Open Common Bile Duct Exploration (indications/role in the modern era, technique, outcomes/complications).- Role of bilioenteric bypass in management of biliary stone disease (how to decide who needs this, technique, results/complications and management).- Endoscopic sphincterotomy for choledocholithiasis – preoperative v. postoperative, techniques, stone fragmentation for large stones, complications and management, outcomes, recent issues of infection with multi-drug resistant bacteria and implications).- Endoscopic ultrasound (EUS)- role in diagnosis and management of choledocholithiasis, transhepatic EUS approaches.- Laparoscopic-assisted ERCP (rendezvous procedures and transgastric ERCP)
Percutaneous techniques (transhepatic drainage)
Overcoming Institutional and Logistical Barriers to LCBDE.