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Updated: Feb 7, 2026
05:36
Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
709
Trans-infundibular choledochoscopy: a method for accessing the common bile duct in complex cases.
Lalin Navaratne1, Jasim Al-Musawi2, Asuncion Acosta Mérida3
1Department of Upper GI Surgery, Northwick Park Hospital and St Marks Hospitals, Watford Road, London, HA1 3UJ, UK. Lalin.navaratne@doctors.org.uk.
Langenbeck'S Archives of Surgery
|July 31, 2018
Summary
In complex laparoscopic surgeries, a trans-infundibular approach (TIA) provides safe access to the common bile duct (CBD) when Calot's triangle is obscured. This method facilitates CBD exploration and stone removal without conversion to open surgery.
Area of Science:
- Minimally Invasive Surgery
- Hepatobiliary Surgery
- Surgical Anatomy
Background:
- Laparoscopic common bile duct exploration (LCBDE) is challenging when severe inflammation or fibrosis 'freezes' the hepatic hilum.
- Conventional transcystic approaches to the common bile duct (CBD) are often precluded in such complex cases.
- Safe access to the CBD is crucial for diagnosis and treatment during LCBDE.
Purpose of the Study:
- To describe a safe and effective trans-infundibular approach (TIA) for accessing the CBD.
- To evaluate TIA as an alternative in cases where conventional dissection of Calot's triangle is impossible.
- To assess the feasibility and outcomes of TIA during LCBDE.
Main Methods:
- Retrospective review of 154 patients undergoing LCBDE between 2014 and 2018.
- Analysis of outcomes including successful CBD access, stone clearance, conversion rates, and complications.
- Specific focus on patients where TIA was utilized for CBD access.
Main Results:
- Nine patients (5.8%) successfully underwent CBD access via TIA.
- Trans-infundibular approach-LCBDE achieved an 86% stone extraction rate.
- Zero conversions to open surgery and minimal post-operative complications were observed, with a median hospital stay of 3 days.
Conclusions:
- Trans-infundibular approach (TIA) is indicated for CBD access in 'frozen' hepatic hilum scenarios during LCBDE.
- TIA allows for transcystic CBD exploration without compromising critical view dissection or necessitating choledochotomy.
- This technique offers a safe alternative for managing complex CBD stones when standard approaches fail.
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