An alternative technique for treatment of choledocholithiasis found at laparoscopic cholecystectomy

R. J. Fitzgibbons Jr, A. A. Ryberg, K. M. Ulualp, N. X. Nguyen, B. S. Litke, J. Camps, T. R. McGinn, J. X. Jenkins and C. J. Filipi
Department of Surgery, Creighton University School of Medicine, Omaha, Neb., USA.

OBJECTIVE: To introduce a new strategy for dealing with abnormal cholangiograms at laparoscopic cholecystectomy that makes postoperative cholangiograms possible and facilitates stone extraction by assuring access to the duct for a guide-wire-assisted endoscopic retrograde sphincterotomy. DESIGN: Retrospective review of a prospectively maintained database. PATIENTS: Twenty-four patients with abnormal cholangiograms had a percutaneously placed double-lumen catheter threaded through the cystic duct and advanced into the duodenum. RESULTS: Ten successful guide-wire-assisted endoscopic retrograde sphincterotomies were performed without complications. Eleven normal postoperative cholangiograms suggested spontaneous stone passage or false-positive intraoperative cholangiograms. There were three technical failures in the early part of the series. CONCLUSIONS: This strategy is a reasonable alternative to laparoscopic common bile duct exploration (1) when the cholangiogram is questionably positive, (2) when prolonged anesthesia (poor-risk patient) should be avoided, (3) when the equipment for laparoscopic common bile duct exploration is not available, and (4) when spontaneous stone passage seems likely. Postoperative endoscopic retrograde sphincterotomy with stone extraction is facilitated when it becomes necessary because a guide wire can be introduced through the catheter.