Posted on 2023-09-20 02:05:22 by Sathish

     This procedure is usually preferred by the laparoscopic surgeons. The presence of one or two large stones in the common bile duct along with dilated common bile duct will be benefited by this procedure. Presence of multiple small stones, intrahepatic stones and lower common bile duct stones will have technical difficulty through laparoscopic technique. However, the presence of choledochoscope will help to overcome these difficulties.

     The procedure is started like laparoscopic cholecystectomy. Usually, five ports are used. Once Calot’s dissection is done, the area of common bile duct (CBD) will be exposed. At this stage, two stay suture are taken over the anterior aspect of CBD and needle aspiration is done to confirm the bile duct. The presence of bile confirms the CBD and the bile duct will be opened with diathermy or harmonic scalpel. At this stage the stone from the bile duct can be retrieved. The presence of pre operative MRCP will help to confirm the number of stones. In case of any doubt intraoperative cholangiogram can be done to know the completion of the stone retrieval. The presence of choledochoscope which visualise the CBD will also help to remove any leftover stone.

     Once the stone removal is complete then a T tube will be placed in the common bile duct through the bile duct opening made for stone extraction. After placing T tube, remaining bile duct opening will be closed with laparoscopic suturing. This T tube will be brought out and will be there for six weeks. Abdominal drain will be placed in the abdominal cavity which is useful to drain the bile leak if any after surgery. Check T tube cholangiogram will be done after six weeks to rule out the possibility of residual CBD stones. Check MRCP will be better option for check T-tube cholangiogram. If no residual CBD stones, then the T tube will be removed.  There will be bile leakage for a short time which will stop spontaneously.

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