Abstract

Intraoperative evaluation of the common bile duct is required for assessment of completeness of stone clearance following common bile duct exploration for management of choledocholithiasis. This is usually done by performing an Intraoperative cholangiography. However, intraoperative cholangiography can miss radio-lucent stones, and can be confusing if air is present in the biliary system. Intraoperative choledochoscopy allows direct visualization and confirmation of completeness of stone clearance. It also permits instrumentation to clear retained stones and to directly obtain mucosal biopsies. However, in most hospitals the flexible choledochoscope is not easily available because of its limited scope of utilization, but the flexible bronchoscope due to its wider use by various departments and specialties, is usually available. Since 2003, we have used the flexible adult video Bronchoscope to perform choledochoscopy in 49 patients undergoing open common bile duct exploration. In 18 patients, retained stones were removed by using the bronchoscope grasping forceps. Mucosal biopsies were performed in 7 patients. We now routinely perform choledochoscopy in all patients undergoing common bile duct exploration by using the bronchoscope. Along with the data, a short video clip is also being presented.

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