■ 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
■ 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.)
■ 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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