A case of common bile duct stone after laparoscopic cholecystectomy, treated by laparoscopic transcystic duct remnant and common bile duct exploration

Abstract

A 41-year-old man was hospitalized for abdominal pain and obstructive jaundice in 2002. He had undergone laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis in 1997. Endoscopic retrograde cholangiopancreatography showed a common bile duct stone (CBDS), and endoscopic sphincterotomy (EST) was attempted, with incomplete extraction of the stone. He refused further treatment and was discharged. The patient was hospitalized again for CBDS in 2004, which was confirmed on magnetic resonance cholangiopancreatography. As he intended to avoid EST, laparoscopic common bile duct exploration was performed. However, the remnant cystic duct was found to be dilated intra-operatively, so laparoscopic transcystic duct remnant and common bile duct exploration was selected. A cholangioscope was inserted into the common bile duct from the cystic duct remnant after intraoperative cholangiography, and the CBDS was extracted using a basket catheter. The postoperative course was uneventful and the patient was discharged on day 3 post-operatively. Laparoscopic transcystic duct remnant and common bile duct exploration is a viable treatment option for patients in whom endoscopic treatment of CBDS has been unsuccessful, particularly when its advantage of preserving papillary function is taken into account.