الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Gall stones are common health problem worldwide common bile duct stones (CBDS)are the second most frequent complication of cholelithiasis and occur in 10 % to 15% of patients. CBDS may be silent and often are discovered incidentally .They may cause jaundice or they may manifest with chiolangitis or gallstones pancreatitis , the pain caused by impacted stone in CBD is similar to biliary colic. Trans-abdominal ultrasound scanning (TUS) is recommended as a preliminary investigation for CBDS and can help identify patients who have a high likelihood of ductal stones. However, clinicians should not consider it a sensitive test for this condition. Endosopic US and MR are both recommended as being highly effective for confirming the presence of CBDS. Intraoperative cholangiography (IOC) and ERCP are generally considered to be the reference standards for diagnosis of CBDS . In the era of laparoscopic surgery, the best approach for common bile duct (CBD) stones remains a matter of debate. The advent of laparoscopic surgery led to a dramatic change in the approach of CBD stones treatment. Indeed, because of an obvious lack of expertise in laparoscopic surgery, surgeons elected to detect and treat preoperatively CBD stones by ERCP since they considered laparoscopic CBD exploration as an unduly, complex, and demanding procedure. The primary laparoscopic approach to CBDS via the cystic duct, therefore avoiding an incision in the common bile duct. Transcystic Choledochoscopy is another laproscopic method allows the removal of stones under direct vision For anatomic variations such as a very distal insertion of the cystic duct into the common bile duct or a very small cystic duct, transcystic stone removal may be precluded. In cases where there are numerous stones , stones that are too large to be brought out through the cystic duct or stones located in the proximal hepatic ducts, direct laparoscopic choledochotomy may be indicated (Watson et al , 2005).