title: Transcystic approach to laparoscopic common bile duct exploration.
abstract: OBJECTIVE
  One-stage laparoscopic management for common bile duct stones in patients with gallbladder stones has gained wide acceptance. We developed a novel technique using a transcystic approach for common bile duct exploration as an alternative to the existing procedures.
  
  
  METHODS
  From April 2010 to June 2012, 9 consecutive patients diagnosed with cholelithiasis and common bile duct stones were enrolled in this study. The main inclusion criteria included no upper abdominal surgical history and the presence of a stone measuring <5 mm. After the gallbladder was dissected free from the liver connections in a retrograde fashion, the fundus of the gallbladder was extracted via the port incision in the right epigastrium. The choledochoscope was inserted into the gallbladder through the small opening in the fundus of the gallbladder extracorporeally and was advanced toward the common bile duct via the cystic duct under the guidance of both laparoscopic imaging and endoscopic imaging. After stones were retrieved under direct choledochoscopic vision, a drainage tube was placed in the subhepatic space.
  
  
  RESULTS
  Of 9 patients, 7 had successful transcystic common bile duct stone clearance. A narrow cystic duct and the unfavorable anatomy of the junction of the cystic duct and common bile duct resulted in losing access to the common bile duct. No bile leakage, hemobilia, or pancreatitis occurred. Wound infection occurred in 2 patients. Transient epigastric colic pain occurred in 2 patients and was relieved by use of anisodamine. A transient increase in the amylase level was observed in 3 patients. Short-term follow-up did not show any recurrence of common bile duct stones.
  
  
  CONCLUSIONS
  Our novel transcystic approach to laparoscopic common bile duct exploration is feasible and efficient.
authors.affiliation: Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Dawei
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhewei
authors.initials: Z
authors.lastname: Fei
authors.affiliation: Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Huang
authors.affiliation: Department of General Surgery, ChongMing Branch, Shanghai XinHua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D003135:Common Bile Duct / Q000601:surgery*; D003549:Cystic Duct; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged
keywords: CBD stones; One-stage laparoscopic management; Transcystic approach