Laparoscopic CBD exploration using a V-shaped choledochotomy

Abstract

BackgroundLaparoscopic common bile duct exploration (LCBDE) is a treatment modality for choledocholithiasis. The advantages of this technique are that it is less invasive than conventional open surgery and it permits single-stage management; however, other technical difficulties limit its use. The aim of this article is to introduce our novel technique for LCBDE, which may overcome some of the limitations of conventional LCBDE.Since December 2013, ten patients have undergone LCBDE using a V-shaped choledochotomy (V-CBD). After the confluence of the cystic duct and the CBD were exposed, a V-shaped incision was made along the medial wall of the cystic duct and the lateral wall of the common hepatic duct, which comprise two sides of Calot’s triangle. The choledochoscope was inserted into the lumen of the CBD through a V-shaped incision, and all CBD stones were retrieved using a basket or a Fogarty balloon catheter or were irrigated with saline. After CBD clearance was confirmed using the choledochoscope, the choledochotomy was closed with the bard absorbable suture material known as V-loc.ResultsThe diameter of the CBD ranged from 8 to 30 mm, and the mean size of the stones was 11.6 ± 8.4 mm. The mean operative time was 97.8 ± 30.3 min, and the mean length of the postoperative hospital stay was 6.0 ± 4.6 days. All patients recovered without any postoperative complications, except for one patient who developed postoperative pancreatitis. No conversions to laparotomy were observed, and there were no recurrent stones and no need of T-tube insertion.ConclusionsThis report suggests that our novel technique, known as V-CBD, may represent a feasible and straightforward procedure for treating choledocholithiasis, especially when the CBD is not dilated.

Safety and efficacy of a novel continuous incision technique for laparoscopic transcystic choledocholithotomy

“…Therefore, we could easily maneuver the choledochoscope into the hepatic duct and common bile duct, and it was not very difficult to suture the right edge of the cystic duct wall and the left edge of the common bile duct. There were no retained stones in the two previous reports or the present study, thus supporting entirely opening the cystic duct to avoid retained stones . Previous studies have considered patients with unsuccessful preoperative EST for BDS to be complex cases , and these assessments are consistent with this study.…”

“…Kim et al . reported 10 cases of a V‐shaped choledochotomy with incision of the medial wall of the cystic duct . They incised the common hepatic duct and cystic duct, but it may be technically difficult to incise and suture the non‐dilated common hepatic duct.…”

“…Additionally, in our study, 39% of the patients had had previous abdominal surgery, including eight who had previously had gastrectomy. Two recent reports did not comment on the complexity arising from patients' medical history . Complication rates for laparoscopic choledochotomy have been reported to be between 1.2% and 18% for the transcystic approach and between 7% and 18.74% for the direct choledochotomy approach .…”

Alternative laparoscopic techniques for stone extraction during laparoscopic CBD exploration: pros and cons

“…6 LCBDE requires specialized laparoscopic equipment and techniques and should be done by surgeons with advanced laparoscopic skills. 4 LCBDE is relatively contraindicated in patients with acute cholangitis, impacted stone in ampulla of vater, severe biliary pancreatitis and severe comorbidity for whom ERCP with ES should be done preoperatively while in fit patients with ASA I and II one stage LCBDE is the better option. 14 LCBDE can be performed either through cyst duct or CBD, the trans-cystic approach is preferred than choledochotomy as it is less invasive, safe and efficient.…”

Safety and efficacy of laparoscopic versus open surgery in management of common bile duct stones: experience at the Sohag University Hospital, Egypt

“…15,16 Although it is safe and highly effective method in the management of CBDS, It requires surgeons with advanced laparoscopic experience and skills, advanced laparoscopic techniques and equipment. 17,18 Laparoscopic treatment for CBDS is a safe, efficient, cost-effective with a high success rate of stone clearance from 84 to 97%, with a morbidity rate 4-16%, and a mortality rate 0-0.8%. Patients treated by LCBDE had a significantly shorter stay in the hospital post operatively with subsequently lower hospital cost compared with those who underwent a two-stage procedure or open surgical approach.…”