Laparoscopic common bile duct exploration. Description of the technique step by step. Video

Abstract

Laparoscopic common bile duct exploration (LCBDE) constitutes, nowadays, a very useful tool in the treatment of biliary tree lithiasis, especially when it is technically impossible to perform an endoscopic retrograde pancreatic cholangiography (ERCP) or in cases when this study is not available.

Method: Using a video, we describe our LCBDE technique step by step, in a 41-year-old patient who consulted for presenting jaundiced skin and mucosa, coluria and hypocolia. Abdominal ultrasound reported gallstones, intra- and extra-hepatic bile duct dilation, a 9-mm diameter common bile duct (CBD) and multiple hyperechoic images suggestive of lithiasis. Since ERCP could not be performed, it was decided to practice LCBDE. Dissection of the Calot’s triangle was performed, identification and proximal ligation of the cystic duct in order to avoid migration of stones to the common bile duct during the procedure, choledochotomy, proximal and distal lavage of the bile duct, exploration with a Fogarty catheter, primary closure of CBD, cysticotomy and placement of catheter for intraoperative cholangiography, verification of fullness of the bile ducts without defect images and adequate passage of contrast to the duodenum, cholecystectomy and placement of subhepatic drainage.

Results: Patient progressed satisfactorily, being discharged on the third postoperative day, uneventfully.

Discussion: LCBDE with primary closure of CBD has been described as a viable and effective alternative for the management of biliary stones, highlighting its lower morbidity and mortality when compared with endoscopic procedures such as ERCP. ^(1,2)