Page 8 - World Journal of Laparoscopic Surgery

Laparoscopic Common Bile Duct Exploration
distal CBD exploration was done using a Fogarty catheter size 6–8 day 2, and the patient was discharged during the following day
fr. (Figs 4 and 5). among their hemodynamic status improve.
Primary CBD closure was done using laparoscopic simple
interrupted PDS 4-0 (Ethicon, Inc., Cincinnati, OH, USA) sutures. Discharge and Follow-up
Intraoperative cholangiography through the cystic duct stump was Patients were discharged once the peritoneal drain was removed.
performed to evaluate residual CBD stones (Fig. 6). Follow-up assessment using ultrasound and the liver function test
The gallbladder portion of the surgery was completed by was carried out for 3–24 months after discharge in the outpatient
clipping the cystic artery and duct using titanium clips—3× clinic if the patient had jaundice or abdominal pain. If either studies
total clips for each structure. Laparoscopic cholecystectomy was revealed abnormalities for possible residual stones, MRCP or ERCP
performed using a cystic-fundus technique with a hook. The was carried out to investigate further biliary compromise.
fundus-abdominal wall suture is cut and using an endo-catch the
gallbladder was extracted through the left paramedial port site. stAtIstIcAl AnAlysIs
The abdominal cavity was drained and checked for bleeding; an The analysis of data was performed using Microsoft Excel databases
active peritoneal drain was placed in the CBD zone. Trocars were and analyzed using the SPSS1 (Statistical Package for the Social
extracted under direct vision, pneumoperitoneum was evacuated, Sciences) 22.0 version. Variables continuous were treated by means
and the abdominal wall was closed using simple interrupted PDS 0 (range). Variables were summarized using median, minimum,
(Ethicon, Inc., Cincinnati, OH, USA) sutures and the skin was sutured maximum values, and percentages.
using Prolene 3-0 (Ethicon, Inc., Cincinnati, OH, USA).
Postoperative Care
The patient ambulated the same day of the procedure and tolerated
oral food intake. The abdominal drain was removed at postoperative

Fig. 1: Trocars position Fig. 2: Gallbladder suspension for exposed Calot’s triangle

Fig. 3: Choledochotomy

6 World Journal of Laparoscopic Surgery, Volume 13 Issue 1 (January–April 2020)