LAPAROSCOPIC ANTEGRADE SPHINCTEROTOMY - A NEW TECHNIQUE FOR THE MANAGEMENT OF COMPLEX CHOLEDOCHOLITHIASIS

Objective Laparoscopic antegrade sphincterotomy represents a new techn ique that expands the ability of the surgeon to manage complex choledo cholithiasis at the time of laparoscopic cholecystectomy. The authors describe their experience with six patients with cholelithiasis and co mplex common bile duct stone disease who underwent successful laparosc opic cholecystectomy and antegrade sphincterotomies. Summary Backgroun d Data Patients with complex choledocholithiasis have represented a te chnical challenge to the minimally invasive surgeon. Recently, a lapar oscopic technique of antegrade biliary sphincterotomy has been reporte d by DePaulo in Brazil, This technique has been successful at clearing the common bile duct at the time of laparoscopic cholecystectomy. Met hods Laparoscopic antegrade sphincterotomy was performed in six patien ts with multiple common bile duct stones. A standard endoscopic sphinc terotome was introduced antegrade via the cystic duct or common bile d uct and guided through the ampulla. A side-viewing duodenoscope was us ed to confirm proper positioning of the sphincterotome. Then a blended current was applied until the sphincterotomy was complete. Results Th ere was no mortality or morbidity associated with laparoscopic antegra de sphincterotomy. The mean additional operative time to complete lapa roscopic antegrade sphincterotomy was 19 minutes. Three of the six pat ients were noted to have transient, asymptomatic elevation in serum am ylase levels immediately after surgery (average 252 international unit s/L; normal < 115), which normalized within 72 hours. The mean postope rative hospital stay was 2.9 days. At a mean follow-up of 5 months (ra nge 1 to 10 months), five patients remain asymptomatic. One individual with acquired immune deficiency syndrome had persistent symptoms, and a diagnosis oi cytomegalovirus pancreatitis was eventually made. Conc lusions Laparoscopic antegrade sphincterotomy appears to be a safe and effective technique for the management of complex biliary tract disea se.