Indraneil Mukherjee, Aleksandr Demin, Thomas Kania, Andrey Mironenko, Karen E Gibbs. Staten Island University Hospital
Introduction: The approach for management of common bile duct stones has been evolving with advances in technology and surgical skills. The superiority of any option remains a matter of debate. Traditional laparoscopic or Open common bile duct explorations are prone to cause strictures of the bile duct. The use of Laparoscopic trans cystic common bile duct exploration (LTCBDE) is gradually increasing among surgeons. Endoscopic Retrograde Cholangio-Pancreatiography is a minimally invasive option but requiring multiple encounters and add more personal and complications to the process. Single site Cholecystectomy is also becoming more popular. Combining Sigle Site Laparoscopic surgery and transcystic common bile duct exploration gives us the option of the least invasive management.
Case Presentation: We present a 28 year old lady who presented with abdominal pain and deranged LFTs. Her LFts improved the next morning and she was discharged home for an outpatient Single Site Laparoscopic Cholecystectomy with Cholangiogram in 3 days. The Surgery was done using a Single site trocar – with a 5 mm rigid 45 o Scope. During the surgery, multiple stones were removed from the cystic duct and the trans cystic cholangiogram showed multiple stones in the Common Bile duct. The stones extraction was initially attempted with an injection of normal saline and intravenous glucagon. As it did not achieve ductal clearance we proceeded with extracting the stone proximally with the help of a balloon. The Final Cholangiogram showed a clean duct. The Cystic duct was ligated, and the gallbladder removed after a Laparoscopic Transversus Abdominis Plane Block. The patient was discharged home. She had an uneventful recovery.
Discussion: There are multiple ways for extraction of common bile duct stone. We do demonstrate Sigle Site Laparoscopic trans cystic common bile duct exploration is a feasible option and the least invasive method for tackling a complex problem.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95314
Program Number: V032
Presentation Session: Exhibit Hall Theater Video Session I
Presentation Type: EHVideo