الفهرس 
Anatomy of the biliary systemOnly 14 pages are availabe for public view
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Abstract
Exploration of the CBD is not an obsolete approach in the management of CBD stones. Laparoscopic exploration of the CBD is highly successful and can achieve satisfactory duct clearance for‘endoscopically irretrievable’ stones. With improved skill, in selected patients laparoscopic bypass can also be performed to improve bile drainage.Intraoperative ERCP can be a perfect salvage treatment for failed preoperative ERCPs, thereby avoiding open surgery. We hope that intraoperative ERCP will become more widely used in the future, not to compete with the indications for preoperative ERCP, but to prevent it from being unnecessarily used in patients at intermediate risk for CLD. It is also a final diagnostic alternative to sophisticated radiological techniques that are not always available at every hospital centre worldwide. LC and intraoperative ERCP is an attractive option in centers that are able to provide a team approach to the management of choledocholithiasis. This approach is a single-stage treatment that reduces the hospital stay and costs. It also decreases unnecessary ERCP and eliminates the need to return to the operating room following technical failure of ERCP. However, the best treatment choice for any patient with CBDS must be based on locally available expertise and resource. Laproscopic common bile duct exploration (LCBDE) and endoscopic sphinctrotomy /laproscopic cholecystectomy (ES/LC) are safe, micro-invasive, and suitable for patients with CBDS and can replace the traditional open common bile duct exploration (OCBDE). Moreover, (LCBDE) is better than ES/LC in terms of therapeutic values, especially when the diameter of CBD is greater than 1 cm. The routine use of (LCBDE) and (ES/LC) is strongly advocated. If the CBD diameter [1 cm, then (LCBDE) will be the safer method whereas, if the CBD diameter less than 1 cm, and also CBDS diameter\1 cm, then (ES/LC) will be a better choice.