[Laparoscopic choledocho-duodenostomy].
It is widely accepted today, that laparoscopic exploration of the common bile duct is an effective method for the treatment of obstructive jaundice, when it is caused by ductal calculi. In case of periampullary lesions, endoscopic stenting or surgical biliodigestive diversion might be the treatment of choice when radical solution is impossible or not necessary. The latter is still performed by laparotomy in a large number of cases due to technical challenges of the biliodigestive anastomosis in the laparoscopic approach. The authors present the case of a 76 year old patient with poor general condition, obstructive jaundice and signs of biliary calculosis by ultrasound. Attempt to its endoscopic verification and treatment has failed, due to lack of cooperation. Laparoscopic common bile duct exploration was performed which has revealed small ductal calculi and stricture of the papilla. After extraction of ductal calculi, hand sutured, side to side choledocho-duodenostomy was performed laparoscopically to achieve permanent biliary diversion. The anastomosis was prepared with absorbable, monolayer, interrupted sutures. The postoperative course was uneventful During regular follow up no complications have been observed. The authors conclude, that in selected cases, choledocho-duodenostomy might be constructed safely laparoscopically, too. This procedure is especially advantageous for elderly patients and for patients in poor condition.
Botos
Akos
A
Sebeszeti Osztály. akos.botos@mst.hu
Bezsilla
János
J
Bende
Sándor
S
D000368:Aged; D002768:Choledochostomy / Q000379:methods*; D004385:Duodenostomy / Q000379:methods*; D042882:Gallstones / Q000150:complications / Q000601:surgery*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology; D010535:Laparoscopy; D008297:Male