Common bile duct stone treatment

  With the change of people’s diet and lifestyle, the incidence of common bile duct stones is gradually increasing, and common bile duct stones are a common and frequent disease in hepatobiliary surgery. The conventional surgical approach is to perform an open choledochotomy to retrieve the stone, after which a T-tube about 30 cm long is placed to facilitate the drainage of bile. The surgery is not only traumatic, the incision is long and the patient is in pain, but also the postoperative hospital stay is as long as 2-3 weeks, and the T-tube can be removed only 2 weeks to 1 month after the surgery, which brings a lot of inconvenience to the patient. Liu Chengli, Department of Hepatobiliary Surgery, Air Force General Hospital Laparoscopic choledochotomy not only results in less trauma and faster recovery, but also enables a significant number of patients to recover early due to the significantly reduced irritation of the lower bile duct and the precise “microscopic” choledochal suture.  The stones are completely removed through 3-4 tiny 0.5-1.0 cm skin incisions in the abdomen under a fully laparoscopic approach, combined with fiberoptic choledochoscopy and lithotripsy mesh, in a 2-3 hour procedure. The patient could eat on the 1st day after surgery, and the abdominal drainage tube was removed on the 2nd day, and the T-tube was removed after 2-3 weeks.  We have improved the technique by implanting a detachable single-tube stent in the bile duct, which can also be placed without a T-tube, and discharging the patient 3 days after surgery, with the specially designed stent discharging itself from the intestine 2 weeks after surgery. The length of stay and cost of hospitalization are significantly reduced.  Laparoscopic cholecystectomy for common bile duct exploration and lithotripsy is technically demanding and requires a surgeon with solid microscopic suturing skills and experience in using a choledochoscope.