Strategy and technique of laparoscopic common bile duct exploration

Area of Science:

• Minimally Invasive Surgery
• Gastroenterology
• Hepatobiliary Surgery

Background:

• Common bile duct stones are frequently encountered, sometimes missed by preoperative imaging.
• Endoscopic retrograde cholangiopancreatography (ERCP) is a common diagnostic and therapeutic tool, but not always sufficient.
• Laparoscopic surgery offers an alternative for managing common bile duct stones.

Purpose of the Study:

• To evaluate the efficacy and safety of laparoscopic common bile duct exploration (LCBDE).
• To assess the technique's ability to completely clear stones without damaging critical anatomical structures.
• To determine the suitability of LCBDE for both suspected and incidentally discovered common bile duct stones.

Main Methods:

• Accessing the common bile duct via the cystic duct, avoiding incision of the common duct or sphincter of Oddi.
• Utilizing balloon dilatation of the cystic duct for choledochoscope insertion.
• Employing techniques such as stone washing, basket extraction, laser, and electrohydraulic lithotripsy for stone removal.

Main Results:

• LCBDE achieves complete clearance of common bile duct stones.
• The technique preserves the integrity of the ampulla of Vater and sphincter of Oddi.
• It successfully manages stones identified preoperatively and those found during intraoperative cholangiography.

Conclusions:

• Laparoscopic common bile duct exploration is a safe and effective method for managing common bile duct stones.
• The cystic duct approach minimizes invasiveness and preserves physiological function.
• LCBDE is indicated for various stone burdens, including large or multiple stones, with options for fragmentation and extraction.