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Abstract
Objective: This case report presents the diagnosis and management of choledocholithiasis.
Method: A 78-year-old female patient, with a history of cholecystectomy 30 years prior, presented with right upper quadrant abdominal pain of 5 days' duration. After investigation, complicated choledocholithiasis with cholestatic syndrome was diagnosed. Endoscopic management (ERCP) was attempted but was unsuccessful due to the size and hardness of the stones. Laparoscopic exploration of the biliary tract was then performed, including longitudinal choledochotomy, stone extraction via transcholedochal lithotripsy, and laparoscopic adhesiolysis.
Results: Lithotripsy allowed for the fragmentation and extraction of large stones (2 cm and 1,2 cm), which were impossible to resolve endoscopically. The patient recovered favorably and was discharged with medical treatment and multidisciplinary follow-up.
Discussion: This case highlights laparoscopic lithotripsy as an innovative and effective technique, offering a definitive alternative when ERCP fails or is not indicated.
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