Laparoscopic choledochoduodenostomy

Laparoscopic cholecystectomy has become the gold standard for treatment of patients with symptomatic cholelithiasis. Management of common bile duct stones in the era of laparoscopy is an area of controversy. Although perioperative endoscopic retrograde cholangiography remains as a widely used procedure, experience is accumulating on the exploration of the common bile duct with the laparoscope. A biliary drainage procedure is indicated in selected patients with choledocholithiasis. Initially described by Reidel in 1892, side-to-side choledochoduodenostomy has become a popular biliary-enteric anastomosis technique in the last century. We describe two patients with recurrent choledocholithiasis and biliary obstruction due to benign biliary strictures. Both patients underwent laparoscopic common bile duct exploration and stone extraction. A side-to-side choledochoduodenostomy is then performed laparoscopically as a drainage procedure. Laparoscopic choledochoduodenostomy resulted in resolution of jaundice and relief of biliary obstruction. Laparoscopic choledochoduodenostomy can be an acceptable alternative to the open choledochoduodenostomy. In addition to a tension-free anastomosis and an adequate-sized stoma, intracorporeal suturing and knot-tying skills are also essential to the success of this procedure.