Laparoscopic Exploration of the Common Bile Duct with a Rigid Scope in Patients with Problematic Choledocholithiasis

Abstract

Background

The development of laparoscopic cholecystectomy as a minimally invasive approach to eliminate gallstones, in conjunction with increasingly sophisticated techniques for removal of common bile duct (CBD) stones by endoscopic sphincterotomy, has revolutionized the treatment of choledocholithiasis. We describe a new technical approach to laparoscopic exploration of the CBD after unsuccessful endoscopic stone extraction.

Methods

Eleven patients were subjected to laparoscopic exploration of the CBD with choledochotomy using a rigid scope (24-Fr nephroscope) during the last 2 years. Of these patients, 10 had unsuccessful preoperative (7 cases) or intraoperative (3 cases) stone extraction, and 1 case had a single impacted stone 2.3 cm in diameter. Five patients had a single bile duct stone and 6 patients had multiple stones. The size of the stones ranged from 9.5 to 24 mm (mean = 12.6 ± 4 mm).

Results

Balloon dilation of the papilla of Vater was done in all patients. Most of the stones were fractured and pushed into the duodenum with rigid grasping forceps but a lithotripter was required in 2 patients. Stone clearance was 100%; complications related to the procedure were not observed. After CBD clearance, primary closure of the choledochotomy was achieved in 10 patients. In 1 patient who had CBD perforation during a previous procedure, choledochotomy was closed over a T-tube. The mean operative time was 124 ± 26.7 min (range = 84–165 min) and the mean postoperative hospital stay was 4 ± 1.7 days (range = 3–7 days).

Conclusions

Laparoscopic exploration of the CBD with a rigid scope is an efficacious procedure in dealing with unsuccessful endoscopic stone extraction.

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Acknowledgments

We thank Dr. H. Altay (Radiologist) for meticulously interpreting the ultrasonography and intraoperative cholangiography images. We also thank Dr. F. Gurbuz (Urologist) for helping us become familiar with the use of the rigid nephroscope in the initial cases.

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Correspondence to Ahmet Tekin.

Electronic supplementary material

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Supplementary material 1 (Video clip 1) Dissection of the distal part of the CBD and choledochotomy (MPG 12840 kb)

Supplementary material 2 (Video clip 2) Introducing the rigid scope into the CBD (MPG 10552 kb)

Supplementary material 3 (Video clip 3) Balloon dilatation of the papilla of Vater (MPG 7554 kb)

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Tekin, A., Ogetman, Z. Laparoscopic Exploration of the Common Bile Duct with a Rigid Scope in Patients with Problematic Choledocholithiasis. World J Surg 34, 1894–1899 (2010). https://doi.org/10.1007/s00268-010-0534-0

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Keywords

  • Common Bile Duct
  • Common Bile Duct Stone
  • Acute Cholangitis
  • Common Bile Duct Exploration
  • Stone Extraction