Background: Common bile duct stones are a difficult problem often leading to conversion to an open operation and/or repeated endoscopic procedures. Both strategies are associated with added morbidity to the patient.
Methods: A new technique was developed to perform a traditional sphincteroplasty using minimally invasive methods. The procedure was performed on two patients with distal common bile duct stones; each patient had at least two unsuccessful pre-operative endoscopic retrograde cholangiopancreatography (ERCP) procedures by at least two different experienced endoscopists. Results:In both patients, a transduodenal sphincteroplasty was successfully completed. In addition, a transduodenal common bile duct exploration was performed at the time of sphincterotomy, successfully clearing the common bile duct in both cases. There were no untoward postoperative sequelae. Follow-up at one-year was complete in both patients. Conclusions: Laparoscopic transduodenal sphincteroplasty can be safely performed in patients with common bile duct stones refractory to ERCP. This technique offers a new approach to the management of common bile duct stones, and can spare patients the need for an open operation or susbequent endoscopic procedure.
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