Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision.

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Biliary Tract Surgery

Background:

• Cholelithiasis frequently coexists with common bile duct (CBD) stones in 10-15% of cases.
• Laparoscopic CBD exploration (LCBDE) is a standard treatment, but traditional methods risk biliary stricture and leakage.
• Transcystic LCBDE can be challenging due to narrow cystic ducts, hindering choledochoscopy.

Purpose of the Study:

• To introduce a modified micro-incision technique for LCBDE.
• To reduce the incidence of biliary stricture and leakage post-LCBDE.
• To enhance the success rate of choledochoscopy during LCBDE.

Main Methods:

• A novel micro longitudinal incision (5-10 mm) was made along the cystobiliary junction toward the CBD.
• This technique was used for LCBDE as an alternative to traditional anterior wall or purely transverse transcystic incisions.
• The modified incision aimed for less invasiveness and better ductal wall preservation.

Main Results:

• The micro-incision technique facilitated easier CBD exploration.
• Preservation of ductal wall integrity was achieved, potentially reducing complications.
• The approach supports primary closure, indicating a favorable safety profile.

Conclusions:

• The modified micro-incision LCBDE technique is a less invasive approach for CBD stones.
• It offers potential benefits in reducing biliary complications and improving procedural success.
• This method presents a viable alternative for surgical management of common bile duct stones.