Contraindications General

■ High risk patients (ASA III or IV) for whom an endoscopic approach is preferred

■ Dense peritoneal adhesions due to previous upper abdominal surgery (a limitation for the laparoscopic approach)

■ Liver cirrhosis with portal hypertension/severe coagulation disorders

Transcystic

■ Presence of obstructive cystic valves (associated with a risk of instrumental CD or CBD injury)

■ Stones too large for TC stone extraction

■ Stones located in the common hepatic duct or in intrahepatic bile ducts

■ Inadequate biliary anatomy of the CD (tortuous, etc.) and the CD-CBD junction (parapapillary insertion, acute angle of insertion of CD into CBD, etc.)

Choledochotomy

■ Thin CBD (risk of stricture after suturing)

■ The presence of severe inflammation (gangrenous cholecystitis, acute necrotizing pancreatitis, etc.) at the porta hepatis, precluding a safe identification of CBD

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