Laparoscopic Bile Duct Exploration Using Video-gastroscope

Background: Laparoscopic bile duct exploration (LBDE) is now a standard procedure in many centers for the management of ductal stones in calcular GB patients. The lowest incidence of retained CBD stone after duct exploration is achieved only with the use of operative choledochoscopy. Available choledochoscopes are so fragile, with fine channels and minimal control of movements. Aim of the work: The authors have explored the use of video-gastroscope device in performing LBDE through direct choledochotomy only in patients with dilated ducts >12mm. Patients and method: Consecutive 20 calcular GB patients with stones in a dilated bile duct were subjected to LBDE using video-gastroscope introduced through a 12 mm disposable port. Concomitant cholecystectomy was done in all cases. Results: There was no peri-operative mortality, only one conversion to open procedure (5%). The mean operative time was 90 minutes; mean hospital stay was 3 days (patients were discharged home with T-tube in place). Conclusion: The use of video-gastroscope in LBDE offers the following advantages over standard choledochoscopes: 1) Better steering. 2) Wider field of vision. 3) Better view quality with no need for continuous syringe injections. 4) Wider working channel with wide range of suitable accessories. 5) Durable device.

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