Treatment of Choledocolithiasis by Laparoscopic Exploration of the Bile Tract After Failed Endoscopic Retrograde Cholangiopancreatography

When common bile duct (CBD) stone removal by endoscopic procedure fails, CBD exploration is an alternative procedure. Laparoscopic common bile duct exploration (LCBDE) has been found to be a safe, efficient and cost-effective treatment for choledocholithiasis. Following LCBDE, the clearance may be ascertained by a cholangiogram or choledochoscopy. The common bile duct (CBD) may be closed primarily with or without a stent in situ or may be drained by means of a T-tube or a biliary enteric anastomosis. In our experience, laparoscopic CBD exploration fortreatment of choledocholithiasis (with or without cholelithiasis) is a safe, viable and cost-effective option. Although closure of the CBD over an antegrade stent is a feasible option but Choledochoduodenostomy, choledochojejunostomy, or sphincteroplasty are used in the treatment of selected patients with retained, recurrent, and impacted bile duct stones; strictures of the bile ducts; stenosis of the sphincter of Oddi; pancreatitis associated with biliary disease; choledochal cysts; fistulas of the bile duct; and biliary obstruction, either benign or malignant.

In this video you will see:

Failed ERCP in clearance of CBD due to a big, impacted stone. Laparoscopic common bile duct exploration and choledochoscopy.Removal of a biliary stent inserted at the time of failed ERCP in removal CBD stone to relieve symptoms of cholangitis.Intra-operative choledochoscopy (hybrid flxible endolaparoscopy). Laparoscopic Choledochoduodenostomy.