Video. Laparoscopic common bile duct exploration and holmium laser lithotripsy: a novel approach to the management of common bile duct stones.
BACKGROUND
Endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic common bile duct exploration (LCBDE) have proved to be safe and effective ways of managing common bile duct (CBD) stones. Clearance of large or impacted CBD stones by routine endoscopic maneuvers can be challenging, often requiring more invasive techniques such as open CBD exploration, which increases morbidity. This report presents a novel approach to managing impacted CBD stones using laparoscopic transcystic common bile duct exploration and holmium laser lithotripsy with favorable outcomes.


METHODS
This retrospective review analyzes five patients who underwent laparoscopic cholecystectomy with intraoperative management of impacted CBD stones via LCBDE and holmium laser lithotripsy. The technique is described, and outcomes are measured. Data via chart review and use of intraoperative video were obtained with institutional review board approval.


RESULTS
Stone clearance from the CBD was achieved for all the patients. The median age of the patients was 39 years. The diameters of the CBDs ranged from 10 to 20 mm, and the median number of stones was one. No mortality was associated with this procedure, and the median hospital stay was 2 days.


CONCLUSIONS
Laparoscopic CBD exploration via a transcystic approach together with holmium laser lithotripsy is a safe and effective way to clear large solitary or impacted CBD stones. This technique also avoids choledochotomy and may be used in concert with other methods such as ERCP, percutaneous cholangioscopy, and open exploration.
Varban
Oliver
O
Department of General Surgery, Wake Forest University Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
Assimos
Dean
D
Passman
Corey
C
Westcott
Carl
C
D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy; D053844:Lasers, Solid-State; D017602:Lithotripsy, Laser; D012189:Retrospective Studies; D014741:Video Recording