Background: Common bile duct stones are a difficult problem, often leading to conversion to an
open operation or repeated endoscopic procedures. Both strategies are associated with added morbidity.
Materials and 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 previously undergone at least two unsuccessful preoperative
endoscopic retrograde cholangiopancreatography procedures by at least two different experienced
endoscopists.
Results: In both patients, a laparoscopic transduodenal sphincteroplasty was successfully completed.
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 satisfactory in both patients.
Conclusion: Laparoscopic transduodenal sphincteroplasty can be safely performed in patients
with common bile duct stones refractory to endoscopic retrograde cholangiopancreatography. 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 subsequent endoscopic procedures.
