Laparoscopic Management of Biliary Stone Disease

Management Protocols

Asymptomatic Cholelithiasis	Incidental Finding on Sonogram
Acute Cholecystitis	Cholelithiasis on Sonogram, clinical Cholecystitis diagnosis or Positive Pipida Scan
Symptomatic Cholelithiasis	Positive Sonogram, normal Liver Function Tests
Cholelithiasis with Suspected Choledocholithiasis	Abnormal Liver Function Tests (Serum Transaminases elevation or Bilirubin >3.0, gallstone pancreatitis)
Cholelithiasis with Choledocholithiasis	CBD Stone on Sonogram, MR Cholangiography or Jaundice
Cholelithiasis with Resolving Gallstone Pancreatitis	Pancreatitis on Sonogram, CT or MER Cholangiography or clinically, Documented High Serum Amylase and Lipase - WITH - Decreasing Serum Pancreatic Enzymes after initial attack

MANAGEMENT PROTOCOLS FOR UNCOMPLICATED BILIARY STONE DISEASES	PROPOSED MANAGEMENT
Asymptomatic Cholelithiasis	No Surgical Intervention
Asymptomatic Cholelithiasis in Diabetic Patients	No Surgical Intervention
Symptomatic Cholelithiasis or Acute Cholecystitis	LapChole
Symptomatic Cholelithiasis with Suspected Choledocholithiasis	LapChole with Insertion of Cystic Duct Cannula with Cholangiography, if Choledocholithiasis, postop ERCP
Symptomatic Cholelithiasis with Choledocholithiasis	LapChole with Insertion of Cystic Duct Cannula with Cholangiography, if Choledocholithiasis, postop ERCP
Cholelithiasis with Resolving Pancreatitis	LapChole with Insertion of Cystic Duct Cannula with Cholangiography, if Choledocholithiasis, postop ERCP
Cholelithiasis with Unresolved Pancreatitis	After acute phase subsides, MRI Cholangiography or ERC, if Choledocholithiasis ERCP followed by LapChole
Asymptomatic Gallbladder Polyps	No Surgical Intervention
Symptomatic Gallbladder Polyps	LapChole
Severe, Gangrenous Cholecystitis with Subhepatic Phlegmon	LapChole, if not safely feasible, Anterior-subtotal LapChole
Post Cholecystectomy (Lap or open) Suspected Choledocholithiasis	MR Cholangiogram or ERC
Post Cholecystectomy (Lap or open) Choledocholithiasis	ERCP, if failure Laparoscopic Common Bile Duct Exploration.