Phrompirun Wattanawiggid, MD, Poschong Suesat, MD, Petch Kasetsuwan, MD, Panot Yimcharoen, MD. Bhumibol adulyadej hospital
The video presents the results of laparoscopic choledochoduodenostomy (CDD) was performed on 70-year-old female patient with impact stones in the distal part of common bile duct (CBD). This patient had cholelithiasis in the CBD which cannot be removed by Endoscopic Retrograde Cholangiopancreatography (ERCP). The single pigtail stent was placed to drain bile from obstruction. The laparoscopic port was placed by 4 trocars in standard cholecystectomy positions. Stone Forcep, saline flushing technique and intraoperative choledochoscope was used for removed stone. But in this case CBD stone could not be removed due to large impacted stone. Ten millimeters diameter end-to-side CDD anastomosis was performed with interrupted sutures over small silicone stent. The operative time was 136 min. Estimated blood loss is about 50 ml. There was no conversion. The hospital stay was 7 days. There was no mortality. On the follow up, patients showed excellent results with normal liver function test.
In conclusion, the laparoscopic choledochoduodenostomy is proven effective and could be considered as feasible technique for treatment of patients with impact distal CBD stone which cannot be removed by preoperative ERCP or intraoperative maneuver. The utilization of a small silicone stent with fixation by suture yielded an anastomotic patency for couple weeks