Laparoscopic common bile duct exploration using V-Loc suture with insertion of endobiliary stent

Abstract

Background: The treatment of concomitant gallbladder (GB) and common bile duct (CBD) stones is still variable, without a standard treatment protocol. Endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy is widely being used, but laparoscopic common bile duct exploration (LCBDE) is also being widely performed. We present our method of LCBDE, with anterograde insertion of an endobiliary stent and primary closure of the CBD using unidirectional barbed suture.

Methods: From November 2013 to March 2015, LCBDE was performed on 15 consecutive patients. Chart review was performed to analyze demographic data and perioperative data. After dissection of the GB from the liver bed, the CBD is dissected and a choledochotomy is made. A choledochoscope is inserted in the CBD, and using various methods, CBD stones are extracted. An endobiliary stent is inserted, and the CBD is closed using unidirectional barbed sutures.

Results: Mean age of the patients was 64.7 ± 12.5 years. Of the 15 patients, six patients (40 %) were male and nine patients (60 %) were female. The average operation time and postoperative stay were 90.7 ± 32.5 min and 4.3 ± 1.2 days, respectively. There were no significant complications such as postoperative bleeding, bile leakage, or biliary stricture.

Conclusions: LCBDE using barbed V-Loc suture with insertion of endobiliary stent is a safe, feasible treatment modality that is easily reproducible. Our preliminary results show a zero complication rate, with an acceptable operation time.

Keywords: Choledocholithiasis; Common bile duct diseases; Laparoscopy.