Transcystic approach of laparoscopic choledochoscopy for choledocholithiasis

Elmeligy, Hesham A.; Abdalgaleil, Mohamed M.; Esmat, Mohamed E.; Nafea, Ayman E.; Abbas, Mohamed; Gomaa, Amr M.

doi:10.4103/ejs.ejs_72_21

Transcystic approach of laparoscopic choledochoscopy for choledocholithiasis

Authors

Abstract

Background
The best management strategy for common bile duct (CBD) stones remains debatable. The use of laparoscopic transcystic common bile duct exploration (LTCBDE) is gradually rising in comparison with conventional CBD exploration that can lead to bile duct stenosis.
Aim
The aim of the present study was to evaluate the safety and feasibility of transcystic approach of CBD exploration (LTCBDE).
Patients and methods
This prospective quantitative clinical study was carried out in Theodor Bilhariz Research Institute and Damanhur Teaching Hospital from 2017 to 2019. CBD stones were present in 40 (7.8%) of 512 patients who underwent laparoscopic cholecystectomy, where these 40 patients underwent LTCBDE and laparoscopic cholecystectomy in one stage.
Results
The procedure was completed in 38 (95%) patients through transcystic approach, and two patients were converted to choledochotomy with T tube insertion (5%). Retained stone had occurred in one (2.5%) patient, so success rate was 92.5%. Mortality was nil. No patients were lost to follow-up (median: 30 months; range: 6–36 months). No signs of bile stasis, no recurrent ductal stones, and no biliary stricture were observed.
Conclusions
With proper selection of cases, LTCBDE is an effective single-stage procedure for the treatment of gall bladder and CBD stone in one session avoiding the drawbacks of endoscopic retrograde cholangiopancreatography as well as open CBD approach.

Keywords