Laparoscopic Choledochoduodenostomy: One of Its Kind Operation for Common Bile Duct Stones

Abstract

Introduction: Recently, endoscopic techniques have replaced surgery for management ofcommon bile duct stones. Surgery is mainly reserved for situations where endoscopicexpertise fails or is not available. We describe here our experience with laparoscopiccholedochoduodenostomy and its outcomes in patients with common bile duct stones.Methods: A retrospective chart review of all patients with common bile duct stonesundergoing the operation at Civil Service Hospital, Kathmandu, Nepal between October 1,2012 and September 29, 2022 was done. Clinical, laboratory and radiological data wasreviewed, along with the intraoperative characteristics, complications, hospital readmissionsand follow-up data were recorded.Result: Sixteen patients were operated; mean age of the patients was 49.86+9.28 years(range 37–68 years); there were 10 females (62.5%) and 6 (37.5%) males; most commonpresenting symptom was abdominal pain followed by nausea/vomiting, and fever. There waspast history of failed endoscopic intervention in 3 patients. The mean common bile duct sizeon MRCP was 18+4.3 mm (range 15-23 mm). Two patients (12.5%) needed conversion toopen operation. Mean operative time was 165.47+17.34 min (range 125-210 min), totalhospital stay was10.68+7.43 days (range 6-19 days). Morbidity occurred in 5 patients(31.25%). There was no mortality in the immediate postoperative period and no occurrenceof sump syndrome.Conclusion: Laparoscopic choledochoduodenostomy extends the benefits of minimallyinvasive techniques; though due to the unique sump syndrome occurring in this operation,other techniques have been also adopted, but they are more complex. Ultimately the choiceof biliary bypass depends on the experience and ability of the surgeon. The present serieshas provided acceptable outcomes in these patients, and this is a safe, effective and feasiblebiliary bypass procedure. This series will help us be more prepared for more increasingnumber of complex scenarios like after failed endoscopic interventions or in stones occurringafter Roux-en-Y gastric bypass.