An intraoperative cholangiogram during laparoscopic cholecystectomy reveals a filling defect in the common bile duct (CBD). The CBD diameter is 10 mm. What is the most appropriate next step?
- A Laparoscopic transcystic CBD exploration if stone ≤6 mm; consider laparoscopic choledochotomy if larger ✓
- B Convert to open surgery and perform immediate common bile duct exploration
- C Complete cholecystectomy and proceed to ERCP with stone extraction postoperatively
- D Leave the stone and prescribe ursodeoxycholic acid
Correct answer: A. Laparoscopic transcystic CBD exploration if stone ≤6 mm; consider laparoscopic choledochotomy if larger
Explanation
When an intraoperative cholangiogram reveals CBD stones, the ideal approach is immediate laparoscopic clearance: transcystic exploration for stones ≤6 mm accessible via the cystic duct, or laparoscopic choledochotomy for larger stones. This single-stage approach avoids a second procedure. ERCP is an acceptable alternative when laparoscopic CBD clearance is not feasible.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.