Transluminal Correction Of The Duodenal Sphincter

Case report: This video shows basic aspects of minimally invasive endoluminal sphincter correction due to distal common bile duct (CBD) stenosis. The patient is a 67-year-old male, who did not succeed after ERCP traeatment of the stricture. The patient suffered from stones in the common bile ducts, CBD extension and elevated level of the enzymes of liver. In the last 14 years, numerous stenting and ERCP of common bile ducts were performed, without any result. A MRI ERCP was ordered and revealed stenosis in lower bile ducts, without any sign of the cancer. Intervention: A laparoscopic correction of the duodenal sphincter was done. The patient was positioned in the split-leg set. Once common bile duct dissected, cholangiogram did not revealed any stones, only a slight restriction. Via a 10 cm duodenal incision, a sphincter correction was done using a catheter. The duodenum was closed with 2 layers. Results: There wasn' t any complications during the surgery. On POD1 no leakage was observed. The patient was on a diet and went home on POD3. Conclusion: Laparoscopic sphincter correction in common bile ducts restriction resulted to be a secure and applicable procedure, which can be an option to cholodochoduodenostomy. Authors: Trelles Nelson, MD, Palermo Mariano, MD, Gagner Michel, MD