Pure Laparoscopic Choledocho-duodenostomy

Abstract

Aims: The aim of the video is to present a stepwise laparoscopic choledocho-duodenostomy. Methods: A video showing the different steps of the procedure is presented focusing on technical factors. Results: A 73-year-old male patient with medical history of open subtotal gastrectomy for a gastric tumor and cholecystectomy 9 years ago presented with abdominal pain. A Magnetic resonance cholangiopancreatography (MRCP) performed showed multiple choledocholithiasis and dilatation of common bile duct (11 mm). It was decided to perform a full laparoscopic choledocho-duodenostomy. A generous Kocher maneuver was performed to allow sufficient mobility of the duodenum to enable construction of a tension-free anastomosis. A 2.5 cm longitudinal incision was made on the anterior surface of the supraduodenal common bile duct. The duodenotomy was shorter in length than the ductotomy. The anastomosis was constructed in a way that anastomoses the bile duct transversely to the longitudinally-oriented duodenotomy. Two corner 4-0 absorbable sutures were positioned between the midpoints of the ductotomy and proximal and distal aspects of the duodenotomy. Full-thickness sutures were made to approximate the ductal mucosa to duodenal mucosa. The operation time was 170 minutes. The postoperative course was uneventful and the patient was discharged on postoperative day 2. Conclusions: Viewing the video can help surgeons to perform this technique in a systematic way.