Laparoscopic Transcholedochal Exploration

  • Miguel A. Hernández
  • B. Fernando Santos
  • Morris E. FranklinJr
Chapter

Abstract

Laparoscopic transcholedochal common bile duct exploration (LTCD) is a versatile technique for the treatment of choledocholithiasis based on the traditional technique of open common duct exploration. LTCD permits access to the proximal and distal biliary ducts and allows the surgeon to use a variety of instruments to clear the bile duct of stones and ensure biliary drainage. A stepwise approach to ductal clearance starting with the simplest interventions first is recommended. LTCD is an advanced laparoscopic procedure and requires appropriate patient selection and suturing skill to reduce the risk of complications. Options for closure of the choledochotomy include primary closure, closure over a T-tube, and primary closure with a biliary stent. A large experience with LTCD shows that this procedure can be performed safely, but there is a higher risk of bile leak compared to transcystic exploration that requires vigilance by the surgeon.

Keywords

Intraoperative cholangiogram (IOC) Laparoscopic cholecystectomy Choledocholithiasis Endoscopic retrograde cholangiopancreatography (ERCP) 

Supplementary material

Video 7.1

Bile duct exploration in a patient with a retained stone after laparoscopic cholecystectomy. The patient had a prior history of Roux-en-Y gastric bypass, precluding conventional endoscopic retrograde cholangiopancreatography (ERCP) (MP4 694821 kb)

Video 7.2

Bile duct exploration with T-tube closure technique (MP4 78959 kb)

Video 7.3

Bile duct exploration in a patient with large stones. Primary closure plus biliary stent technique is used (MP4 658305 kb)

Video 7.4

Bile duct exploration with choledochoscope-guided biliary stent placement and primary closure (MP4 1473224 kb)

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Miguel A. Hernández
    • 1
  • B. Fernando Santos
    • 2
    • 3
  • Morris E. FranklinJr
    • 1
  1. 1.Department of Minimally Invasive SurgeryTexas Endosurgery InstituteSan AntonioUSA
  2. 2.Department of SurgeryGeisel School of Medicine, Dartmouth CollegeHanoverUSA
  3. 3.Veterans Affairs Medical Center, White River JunctionHartfordUSA

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