Laparoscopic Common Bile Duct Exploration and Laser Lithotripsy: A Novel Approach to Management of Common Bile Duct Stones

Introduction: Common bile duct stones (CBDS) are found in approximately 10% of patients who undergo cholecystectomy. Symptomatic common bile duct stones are a source of significant morbidity as they may cause obstructive jaundice, cholangitis, biliary cirrhosis and pancreatitis. Endoscopic retrograde cholangiopancreatography (ERCP) has been a mainstay of treatment for common bile duct stones. Laparoscopic common bile duct exploration has also proven to be a safe, cost effective and efficacious way of clearing ductal stones. Failure to clear stones by either method however often requires more invasive measures such as open common bile duct exploration, which in turn increases morbidity, hospital length of stay and recovery time. We present a novel approach to managing impacted common bile duct stones by utilizing laparoscopic transcystic common bile duct exploration and holmium laser lithotripsy with favorable outcomes.

Methods: This is a case series of patients undergoing laparoscopic cholecystectomy who had concomitant management of impacted CBDS by laparoscopic transcystic common bile duct exploration and holmium laser lithotripsy. Technique is described and outcomes measured include: ductal clearance, 30-day morbidity and mortality, complications and post-operative hospital length of stay.

Results: Five patients underwent laparoscopic cholecystectomy with common bile duct exploration and laser lithotripsy. All achieved stone clearance from the common bile duct. There was no mortality associated with this procedure with a median follow up of 30 days. Common bile duct diameter ranged from 10mm-20mm and median pre-operative total bilirubin was 3.7 mg/dl. Median length of hospitalization was 2 days.

Conclusions: Laparoscopic common bile duct exploration via a transcystic approach along with holmium laser lithotripsy is a safe and effective way to clear impacted common bile duct stones. Laser lithotripsy is practical for large impacted solitary stones and serves as an additional tool for the laparoscopic surgeon when standard basket removal techniques fail. This technique also avoids choledocotomy and may be used in concert with other modalities, such as ERCP or open exploration.

Session: Podium Video Presentation

Program Number: V036

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