Retained common bile duct stone as a consequence of a fundus-first laparoscopic cholecystectomy

James Dolan, Judith W. Cook, Brett Sheppard

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

The fundus-first technique for laparoscopic cholecystectomy provides an alternative to the conventional dissection technique in patients at high risk for conversion to open cholecystectomy or at risk for bile duct injury. We report the complication of a retained common bile duct (CBD) stone after utilizing this technique. Intraoperative cholangiography (IOC) was not performed due to the concern for causing CBD injury in a patient with significant periductal inflammation and no risk factors for CBD stones. Following discharge, the patient developed scleral icterus 3 days later and returned for evaluation. He required endoscopic retrograde cholangiopancreatography for removal of a CBD stone. None of the four series reporting on this technique have described this complication. It should now be recognized that there is a risk of displacing a gallstone into the CBD in utilizing this technique. This report highlights the importance of intraoperative imaging of the CBD when using this technique, even in patients considered to be at low risk for having CBD stones. If IOC is considered hazardous, then intraoperative ultrasound should be the modality of choice.

Original languageEnglish (US)
Pages (from-to)318-321
Number of pages4
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques - Part A
Volume15
Issue number3
DOIs
StatePublished - Jun 2005

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Laparoscopic Cholecystectomy
Common Bile Duct
Cholangiography
Endoscopic Retrograde Cholangiopancreatography
Wounds and Injuries
Cholecystectomy
Gallstones
Jaundice
Bile Ducts
Dissection
Inflammation

ASJC Scopus subject areas

  • Surgery

Cite this

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abstract = "The fundus-first technique for laparoscopic cholecystectomy provides an alternative to the conventional dissection technique in patients at high risk for conversion to open cholecystectomy or at risk for bile duct injury. We report the complication of a retained common bile duct (CBD) stone after utilizing this technique. Intraoperative cholangiography (IOC) was not performed due to the concern for causing CBD injury in a patient with significant periductal inflammation and no risk factors for CBD stones. Following discharge, the patient developed scleral icterus 3 days later and returned for evaluation. He required endoscopic retrograde cholangiopancreatography for removal of a CBD stone. None of the four series reporting on this technique have described this complication. It should now be recognized that there is a risk of displacing a gallstone into the CBD in utilizing this technique. This report highlights the importance of intraoperative imaging of the CBD when using this technique, even in patients considered to be at low risk for having CBD stones. If IOC is considered hazardous, then intraoperative ultrasound should be the modality of choice.",
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