Appropriate options for management of common bile duct stones identified at laparoscopic cholecystectomy include:

a. Conversion to open cholecystectomy and common duct exploration

b. Transcystic duct dilatation and exploration

d. Complete the laparoscopic cholecystectomy with postoperative ERCP and stone removal

Common bile duct stones found unexpectedly during laparoscopic procedures presents the surgeon with a different set of choices from that of stones found during an open procedure where one would invariably proceed to common duct exploration. The practice of converting to an open procedure for the purposes of common duct exploration is acceptable and should be considered based on the surgeon’s experience and expertise and other options available. Transcystic duct dilatation and exploration with stone removal is being performed in increasing numbers and appears to be safe and effective. Although experience with laparoscopic choledochotomy and common duct exploration has been reported with limited experience, this technique is probably not appropriate for the average surgeon. Many surgeons, depending on their clinical situation, may opt to complete the laparoscopic removal of the gallbladder and proceed to postoperative management of the stone using endoscopic technique.