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The management of symptomatic cholelithiasis during pregnancy remains a serious and difficult problem. This condition may be further complicated by the presence of common bile duct stones (CBDS). Two cases of CBDS in pregnancy are presented. During the period from August 1990 to June 1994, 1127 consecutive patients underwent LC by a single surgical team. Two (0.2%) of these patients were pregnant and both were found to have choledocholithiasis. One patient's stones were lavaged into the duodenum via the cystic duct and the other patient had transcystic choledochoscopy and transcystic duct tube drainage. The patients were discharged from the hospital on postoperative days 4 and 6, respectively. There were no complications and both successfully carried their pregnancies to term. Laparoscopic cholecystectomy (LC) with transcystic common bile duct exploration (TCDE) was advantageous in both patients. Neither patient required an abdominal incision or choledochotomy. Laparoscopic TCDE with or without cystic tube drainage is a viable option in the management of CBDS in the pregnant patient.

With increasing acceptance of routine cholangiography during laparoscopic cholecystectomy (for confirmation of anatomy) there has been increased identification of common duct calculi. A technique of laparoscopic transcystic common duct stone extraction is described and early clinical results are presented. Successful stone extraction was accomplished in 39 out of 41 consecutive attempts by one surgical team. Two cases required choledochotomy. There were four complications including hyperamylasemia (2), minor wound infection (1), and incidental pneumothorax (1). Recommendations regarding safety and indications are presented. Initial evaluation suggests laparoscopic transcystic stone extraction is safe and effective.