Sotelo EJC, Souza GLM, Alanis ME, Salas GAG, Cancino LJA

Language: Spanish
References: 6
Page: 196-199
PDF size: 196.07 Kb.

ABSTRACT

Introduction: There is a low frecuency of choledocholithiasis asociated with gallstones. Those patients that undergo a cholecystectomy and also develope choledocholithiasis vary from 5-11%. Endoscopic retrograde cholangiopancreatography has been the first option to approach in patients with choledocholithiasis, when this is unsuccesful the next step would be open or laparoscopic biliary tract exploration with a T drainage placement or primary common duct closure. A case of a patient undergoing laparoscopic biliary tract exploration and primary closure is reported. Clinical case: This is a 89 year old female with diabetes mellitus and hypertension under medical control that 2 months prior to surgery starts with jaundice. abdominal pain, choluria and soft stools. An unsuccesful cholangiography was performed, therefore she is programed to surgery that included cholecystectomy, transcystic cholangiogram and a 3 cm choledochotomy using a convenctional endoscopic scalpel, laparoscopic choledochoscopy with biliary tract exploration incuding endoprosthesis removal and primary closure of common duct. As main findings, a small nodular liver is reported, scleroatrophic gallbladder, common bile duct of 12 mm in diameter with aproximatelly twelve, 0.5 cm stones. Through choledochoscopy, stones were observed in both hepatic ducts, been able to remove them using a ballon with no complications. The operating time was 210 minutes with an aproximate bleeding of 350 cc. The patient had a stable post op and she is still under follow up as an external patient. Conclusion: Laparoscopic biliary tract exploration with a primary closure of the common duct is feasible in patients with choledocholitiasis.

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