Laparoscopic CBD Stone Removal

Common Bile Duct (CBD) stones may be classified as primary when they originate within the bile duct, or secondary when gallbladder stones migrate into the bile duct. Most CBD stones are secondary in origin.

Patients with CBD stones commonly present with:

• Abdominal pain
• Jaundice
• Fever

Treatment usually involves removal of the gallbladder along with removal of bile duct stones.

CBD stones are usually removed using endoscopic procedures (ERCP), which can be performed either before or during gallbladder surgery.

Large stones that cannot be removed endoscopically require surgical treatment.

Laparoscopic CBD exploration allows direct removal of stones from the bile duct.

• If CBD diameter is greater than 2 cm, choledocho-duodenostomy may be performed.
• If CBD diameter is smaller, the bile duct is closed primarily after stone removal.

Bile Duct Injury and Biliary Stricture

Bile duct injuries most commonly occur during difficult gallbladder surgery (cholecystectomy), especially when there are dense adhesions or abnormal bile duct anatomy.

In complex cases, laparoscopic surgery should be converted to open surgery to prevent complications.

If bile duct injury is suspected during surgery and expert repair is not available, a drain should be placed and the patient should be referred to a specialized tertiary care center.

• Immediate repair may be possible within 48–72 hours if infection is absent
• After 72 hours delayed repair is usually recommended
• Open surgery may be required if vascular injury is present

Diagnostic Evaluation

Imaging studies are essential to evaluate bile duct injuries and biliary continuity.

• MRCP (Magnetic Resonance Cholangiopancreatography)
• HIDA Scan when diagnosis is uncertain
• Ultrasound and CT Scan

Treatment Approach

Management depends on the severity and type of bile duct injury.

• Drain placement in early cases
• Definitive surgical repair
• Biliary reconstruction
• Specialized hepatobiliary surgery

Treatment should ideally be performed at specialized tertiary care centers by experienced surgeons.