Successful Laparoscopic Common Bile Duct Exploration

Christopher W Salzmann, MD, Morris E Franklin, MD FACS, Karla Russek, MD. Texas Endosurgery Institute


* The routine use of intraoperative cholangiogram (IOC) performed by some surgeons at the time of laparoscopic cholecystectomy, also leads to identification of patients with totally unsuspected choledocholithiasis.

*Sequential Technique
-Intraoperative cholangiogram: Road map of the biliary system, ID of biliary stones
-Anterior dissection of common bile duct: Stay sutures, traction on cystic duct
-Flushing the duct: This maneuver will frequently suffice to clear stones
-Choledochoscopy: Direct visualization of the biliary system and stones, stone retrieval with basket, trans-scope cholangiogram
-Placement of T-tube: T-tube tailoring, pre-tied sutures, suture technique
-T-tube cholangiogram
-Completion of cholecystectomy
-Extraction of specimen and stones
-Drain placement

-Laparoscopic CBDE is a safe technique that allows the surgeon a successful exploration of the common bile duct and clearance of stones.
-Systematic, stepwise technique is advised.
-Two-handed laparoscopic suturing techniques are essential

Session Number: Poster – Poster Presentations
Program Number: P368
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