Adrian M Maghiar, MD, PhD, Teodor Maghiar, MD, PhD, Marius Sfirlea, MD, George E Dejeu, MD
Spitalul Pelican Oradea, Romania
Laparoscopic cholecystectomy has become the gold standard in the treatment of gallstones. With increasing experience in laparoscopic surgery, laparoscopic common bile duct exploration has become viable, even a routine in some centers. However the laparoscopic approach for common bile duct stones, confirmed or suspected, remains a complex and controversial topic. In addition cholecystectomy and open coledochotomy for stone extraction which is superior to ERCP, patients receiving laparoscopic cholecystectomy may benefit from intraoperative cholangiography and common bile duct stones extraction in one stage, if it is present. This can be done by exploring the common bile duct by transcystic choledocoscopy or choledochotomy and choledocoscopy.
In our clinic we have an experience of 12 choledocoscopy’s for the extraction of common duct stones with Dormia and Fogarty probes. We used a flexible one working channel choledochoscope introduced through a 10mm trocar placed under the right costal margin. For 4 cases we used Kehr tube choledochal drainage for 2 weeks postoperatively, and in 6 cases we used primary coledocoraphia and subhepatic drainage. Postoperative evolution was favorable in all cases.
In our experience laparoscopic choledochoscopy and common bile duct stone extraction is a feasible method of curative value at least equal to ERCP, but requires expertise in advanced laparoscopic surgery and specialized equipment (choledocoscope).
Session: Poster Presentation
Program Number: P350