Laparoscopic choledochoduodenostomy

Laparoscopic cholecystectomy has become the gold standard for treatment of patients with symptomatic cholelithiasis. Management of common bile duct st ones in the era of laparoscopy is an area of controversy. Although perioper ative endoscopic retrograde cholangiography remains as a widely used proced ure, experience is accumulating on the exploration of the common bile duct with the laparoscope. A biliary drainage procedure is indicated in selected patients with choledocholithiasis. Initially described by Reidel in 1892, side-to-side choledochoduodenostomy has become a popular biliary-enteric an astomosis technique in the last century. We describe two patients with recu rrent choledocholithiasis and biliary obstruction due to benign biliary str ictures. Both patients underwent laparoscopic common bile duct exploration and stone extraction. A side-to-side choledochoduodenostomy is then perform ed laparoscopically as a drainage procedure. Laparoscopic choledochoduodeno stomy resulted in resolution of jaundice and relief of biliary obstruction. Laparoscopic choledochoduodenostomy can be an acceptable alternative to th e open choledochoduodenostomy. In addition to a tension-free anastomosis an d an adequate-sized stoma, intracorporeal suturing and knot-tying skills ar e also essential to the success of this procedure.