Cystic duct dilation during laparoscopic transcystic common bile duct exploration

Abstract

Successful laparoscopic common bile duct exploration (CBDE) is being reported with increasing frequency. Three techniques for accessing common duct stones laparoscopically have been described: (1) laparoscopic choledochotomy, stone extraction and T-tube placement; (2) endoscopic retrograde sphincterotomy to remove common bile duct stones in conjunction with laparoscopic cholecystectomy; and (3) laparoscopic transcystic CBDE. From the viewpoint of preservation of papillary function, shorter hospitalization, reduction of pain, and faster patient recovery, the last method is superior to the former two. In this procedure, the cystic duct should be initially dilated widely, for passage of a flexible small choledochoscope. Here we report a safe and effective technique for dilation of the cystic duct.