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With the advent of laparoscopic techniques and other nonoperative
techniques, the management of patients with common
bile duct (CBD) stones became more complex. With
low, medium or high preoperative suspicion of CBD stones,
three factors influence the correct management: the degree
of endoscopic, radiologic and laparoscopic expertise; the severity
of symptoms; the presence or absence of the gallbladder.
In patients with a low probability of having CBD stones
routine ERCP pre-LC appears inappropriate. The
management of patients with medium probability of CBD
stones depends on the ability of the laparoscopist to remove
CBD stones. A single laparoscopic procedure for cholelithiasis
and CBD stones would be the best approach in
the majority of patients. ERCP should be considered the
proceduce of choice in patients with severe gallstones pancreatitis,
acute cholangitis and in those with a high probability
of having CBS stones.