Laparoscopic transduodenal sphincteroplasty.
BACKGROUND
Common bile duct stones are a difficult problem, often leading to conversion to an open operation or repeated endoscopic procedures. Both strategies are associated with added morbidity.


METHODS
A new technique was developed to perform a traditional sphincteroplasty using minimally invasive methods. The procedure was performed on two patients with distal common bile duct stones; each patient had previously undergone at least two unsuccessful preoperative endoscopic retrograde cholangiopancreatography procedures by at least two different experienced endoscopists.


RESULTS
In both patients, a laparoscopic transduodenal sphincteroplasty was successfully completed. A transduodenal common bile duct exploration was performed at the time of sphincterotomy, successfully clearing the common bile duct in both cases. There were no untoward postoperative sequelae. Follow-up at one year was satisfactory in both patients.


CONCLUSIONS
Laparoscopic transduodenal sphincteroplasty can be safely performed in patients with common bile duct stones refractory to endoscopic retrograde cholangiopancreatography. This technique offers a new approach to the management of common bile duct stones, and can spare patients the need for an open operation or subsequent endoscopic procedures.
Makary
Martin A
MA
Department of Surgery, Georgetown University Medical Center, Washington, D.C., USA.
Elariny
Hazem A
HA
D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D013105:Sphincterotomy, Transduodenal / Q000379:methods*; D016896:Treatment Outcome