A 47-year-old male, with a history of multiple cholelithiasis and multiple choledochal lithiasis, who presented with multiple episodes of cholangitis for which endoscopic treatment (ERCP + stenting) was performed. After 4 unsuccessful attempts to resolve the bile duct by endoscopic approach, it was decided to perform minimally invasive laparoscopic surgery.
In this video we can observe the Choledochotomy, followed by extraction of stones and biliary mud. Subsequently, a choledochoscopy is performed with the laparoscopic camera (10 mm) with infusion of sterile Physiological Solution since the patient had a very dilated bile duct. Choledochorrhaphy is then performed.
Laparoscopic Choledocotomy and Cholecistectomy
Bile duct stones and gallbladder stones
Same as a Cholecystectomy and a laparoscopic neddle holder
No need of further workup as a Cholecystectomy
If there are a complication is always the posibility of a endoscopic rendez-vous and use of Endoscopic Choledoscopy and stones treatment (If its available)
Positive: 1-Step resolution of bile stones, Feasibility, Shorter hospital stay, same reuslts as combination of ERCP + Surgery
Negative: Time of surgery, Surgeon skills
Increased rate of bile duct stricture or fibrosis
Hospital JB Iturraspe
Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc. 2006 Apr;20 Suppl 2:S441-5. doi: 10.1007/s00464-006-0029-0. Epub 2006 Mar 16. PMID: 16544067.
Review Laparoscopic Coledocoscopy.