As suggested by Rohatgi and Singh our dissection concentrated on identifying the GB cystic duct junction and cystic duct CBD junction so that we were able to clear the impacted calculus from within and complete the cholecystectomy, while we resorted to a choledochotomy
to retrieve the calculus from the cystic duct- CBD junction and the stent enabled us to achieve primary closure of the CBD in every case.[12,13] Chowbey et al.
In case of failure; T-tube placement with choledochotomy
was preferred in limited injuries in the lateral surface of the duct in the distal part of the main hepatic duct (type D).
Three of them were treated by Endoscopic Retrograde Cholangio Pancreatography (ERCP) and stones were extracted, 01 had large stone more than 1 cm which was treated by choledochotomy
. Remaining 02 patients had biliary stricture diagnosed on MRCP.
Through laparoscopic approach, a broad choledochotomy
was performed revealing a large villous-looking polyp attached to the posterior-medial wall of the bile duct in the area of the cystic duct, followed by instrumental revision of the biliary tree.
(1-2 cm) was done in the midline of the anterior wall of CBD just distal to cystic duct opening.
was closed with 3-0 polyglactin acid over the T-tube.
In spite of the care taken, sometimes gallstones may be spilled when choledochotomy
of the cystic duct is performed for intraoperative cholangiogram.
The exclusion criteria were as follows: (1) acute cholangitis or septic shock, (2) a history of previous endoscopic sphincterotomy (EST) or endoscopic papillary balloon dilatation (EPBD), (3) coagulopathies (platelet count < 50,000 x [10.sup.3]/[micro]L or aninternational normalized ratio > 1.5), (4) malignant biliary obstruction, (5) a Billroth II, Roux-en-Y, or choledochotomy
anatomy, (6) failure of biliary cannulation or a requirement of precut sphincterotomy, or (7) refusal to undergo SO manometry.
A case of retroperitoneal chylous cyst developed after cholecystectomy and choledochotomy
. Nihon Geka Gakkai Zasshi 1988;89:282-5.
Primary Closure and Rate of Bile Leak following Laparoscopic Common Bile Duct Exploration via Choledochotomy
. Dig Surg.
We performed a choledochotomy
to facilitate the complete evacuation of these dark-brown stones (Figure 3).
Those with common bile duct stoned had cholecystectomy, choledochotomy
, extraction of stones with Desjardin forceps, irrigation of the extra-hepatic biliary tree with sterile saline, and this was completed with insertion of a T-tube.