Video-choledochoscopy in bile duct surgery

The authors report on common bile duct explorations performed in 92 patients and in one patient laparoscopically. In their practice usually ERCP and EST were attempted first when bile duct stones were suspected. Open choledochotomy was performed when the endoscopic approach was unsuccessful, or a stone was detected during selective intraoperative cholangiography. In 16 cases intraoperative video-choledochoscopy was performed. The thing that increased the average operating time by 47 minutes. In 4 patients in this group residual stones were detected postoperatively, presumably because of the inexperience of the surgeons with the use of the choledochoscope. Postoperative cholangiography raised the suspicion of a residual stone altogether in 8 cases. Postoperative ERCP was negative in 2 instances, EST and stone extraction were successful in 3 patients, but unsuccessful in 3 patients. In these last cases a successful reoperation was made in one, ESWL and dissolution therapy were performed in two patients. The authors advise to learn the technique of laparoscopic removal of the bile duct stones and the application of guide-wire, Dormia basket, Fogarty balloon catheter, and balloon dilatator. According to the data of the literature, the one stage laparoscopic procedure is successful in most of the patients, more comfortable, and cost saving.