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13.
Ductus cysticus - naravni vhod za holedoholitotripsijo med laparoskopsko holecistektomijo = The cystic duct - the natural access for choledocholithotripsy during laparoscopic cholecystectomy
Vračko, Jože
For 10 years, the management of patients with biliary calculi was conducted intwo stages comprising laparoscopy and endoscopy. At present, however, one-stage procedures for laparoscopic extraction of ...common bile duct stones are available. In most patients, the calculi have migrated to the common bile duct from the gall bladder through the cystic duct. Therefore it seems logicalto remove them by the same route. In patients harbouring common bile duct stones, the luminal diameter of the patients, the diameter of the largeststone found in the common bile duct is smaller than or equal to the luminal diameter of the corresponding cystic duct, which dilates further when Heister's valves are divided. Thanks to these favourable anatomical circumstance, the success rate of trans-cystic common bile duct stone extraction can be as high as 98%. If the trans-cystic approach fails, laparoscopic choledochotoomy with T-drain placement, classical choledocholithotripsy or postoperative endoscopic papillotomy can be undertaken. The modern one-stage method for common bile duct stone extraction via the cystic duct, representing the natural access to the common bile duct, is undoubtedly justified on ethical and economic grounds.
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