Chronic cholecystitis

If a patient is diagnosed as having chronic cholecystitis, an elective

cholecystectomy is indicated.
Stones in the CBD
This is a controversial topic with many factors to consider. There are several ways
to approach a stone in
the CBD. It may pass on conservative treatment (thankfully the most common
outcome). If there is a
history of jaundice dilated ducts on ultrasonography, many surgeons would request
a preoperative
MRCP to confirm that the ducts are clear before surgery. This is preferable (if
available) to a diagnostic
ERCP, which has higher morbidity. If the ducts are clear, cholecystectomy can be
performed safely. If
there is a stone in the CBD it can be removed either via ERCP preoperatively or at
the time of surgery.
The latter option necessitates an intraoperative exploration of the CBD. A problem
arises if the
cholecystectomy is laparoscopic, which most are. A laparoscopic exploration of the
bile duct is a skilled
procedure and, unless the operator is suitably experienced, there may be long
operating time, significant
morbidity and significant conversion to open surgery.