Laparoendoscopic Management of the Common Bile Duct Stones

Jose Daniel Lozada Leon, MD, Angel Reyes Dorantes, MD, Clodoalda Durthley Lozada Leon, MD, Fret Carreto Arredondo, MD, Aide Colin Armenta, SN

Santa Monica Hospital Cuernavaca, Morelos, Mexico

INTRODUCTION:
The aim of this video is to present a summary of different ways of common bile duct exploration.

The Laparoendoscopic exploration of the common bile duct requires skill and coordination of the surgical team , it can be performed by a transcystic or transcoledocian approach. Between 8 and 19% of the general population may have an unnoticed gallstone in the bile duct , this suggests that in patients with biliary dilatation confirmed pre or intraoperatively and adnormal Liver function test like increases in alkaline phosphatase, bilirubin, or aminotransferasas level, small stones or microlithyasis, bile duct exploration should be considered.

METHODS AND PROCEDURES
We present an easier way to explore the bile duct in patients with dilatation of common bile duct by stone disease, several cases are presented consecutively : transcystic intraoperative cholangiography, extraction of stones with Fogarty catheter by transcystic way, exploration and extraction stones with flexible ureteroscopic with Dormia basket and wave shock electrohydraulic lithotripsy, exploration of common bile duct using Lens 30° of 5 mm through subxyphoid trocar and surgiwand of 5 mm through trocar of 5mm in the right midclavicular line and position the patient in semi-fowler and decubitus right side, transcholedocian Laparoendoscopic exploration and extraction of stone with Dormia basket and balloon Fogarty, T-tube placement, endoscopic sphincterotomy and ERCP, Coledocoduodeno anastomosis and endoscopic view in patient that required that.

RESULTS
The clearance of the bile duct was obtained in all patient except one patient that required choledocoduodenal anastomoses, five patient were referred to an interventional endoscopist to an endoscopic sphincterotomy an ERCP

CONCLUSIONS
We believe that now you can make a proper exploration and clearence of the bile duct in the form of minimally invasive surgery thanks to the technological armamentarium that exists today


Session: Poster Presentation

Program Number: P364

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