TITLE: Laparoscopic Transduodenal Sphincteroplasty
Introduction: This video illustrates the key aspects of laparoscopic transduodenal sphincteroplasty for distal common bile duct (CBD) stricture. We present the case of a 67-year-old man who was referred to us after failure of endoscopic treatment (ERCP) of CBD stenosis. The patient had a history of CBD stones, CBD dilatation, and elevation of liver enzymes. He developed stenosis of the distal CBD that was treated unsuccessfully with multiple ERCP and stent placements over the last 14 years. A preoperative magnetic resonance cholangiopancreatography revealed a dilated CBD tapering in the lower CBD without evidence of tumor.
Methods: A laparoscopic transduodenal sphincteroplasty was performed with the patient in the split-leg position. After the CBD was exposed just above the duodenum, a cholangiogram was performed directly in the CBD, showing no evidence of any CBD stones and a short stenotic area at the ampulla. Then, through a 10-cm longitudinal duodenotomy, a sphincterotomy using the Harmonic scalpel was performed after a transcystic catheter was pushed down through the ampulla. A sphincteroplasty was then performed followed by a 2-layered closure of the duodenum.
Results: The patient tolerated the procedure well. On the first postoperative day, an upper gastrointestinal study showed no evidence of leak. So, diet was resumed safely and the patient was discharged home uneventfully on the third postoperative day.
Conclusion: We conclude that laparoscopic transduodenal sphincteroplasty for CBD stenosis is a safe and feasible alternative to choledochoduodenostomy.
Abs# 9217GS
Authors: Trelles Nelson, MD, Palermo Mariano, MD, Gagner Michel, MD
