Current laparoscopic approaches to pancreatico-biliary disease

Biliary-enteric anastomoses to duodenum or jejunum are a laparoscopic really and will find a place in the management of complicated choledocholithiasis or malignant strictures of the bile duct. Staging by laparoscopy in pancreatic malignancy is an ideal strategy, with some operators able to complete a definitive laparoscopic palliative bypass in the same sitting. Intraoperative laparoscopic sonography is an advancing technique and has great potential in the evaluation of choledocholithiasis, hepatic metastases and staging of pancreatic cancer. Innovative options exist to deal with bile duct calculi, including antegrade sphincterotomy and intraoperative stent placement.