Background : The difficulty arises when recurrent common bile duct stones resist standard endoscopic removal methods. Nevertheless, a laparoscopic strategy can be employed for patients with favorable anatomical conditions to explore the common bile duct. This approach includes choledochoscopy and the creation of a laparoscopic choledochoduodenstomy. By adopting this technique, not only is the procedure safer and minimally invasive, but it also accelerates the recovery process.

Methods : Thirteen patients have undergone multiple attempts at endoscopic retrieval, but none led to clearing the biliary tract. (Surgical procedures) After classic laparoscopic cholecystectomy, the anterior wall of the common bile duct was incised about 2 cm longitudinal length with electrocautery. With choledochoscopy, CBD stones were removed by the stone basket. After the Kocker maneuver, the duodenum wall was incised, matching the size of the CBD wall opening. A 12 cm 6-0 ProleneTM suture was introduced through a 10mm trocar into the abdomen. It was used to stitch the left edge of the CBD and duodenal opening, passing through to the inside. The posterior layer was then sutured continuously to the right edge of the CBD and duodenal opening, with the CBD being sutured from inside to outside. Another 12 cm suture was placed in the abdomen, and the same stitching process was repeated to the right of the previous layer. The final suture passed through the CBD and duodenum at the border, outside the lumen, and the posterior and anterior layer sutures were tied.

Results : All patients exhibited good procedural tolerance and were discharged on the second-day post-surgery. Currently, the patients have experienced a successful recovery, resuming their regular activities without recurrent stone disease for five years (median, 3.8 years).

Conclusions : Laparoscopic choledochoduodenostomy, after a common bile duct exploration with choledochoscopy for recurrent CBD stones, offers a safe and effective minimally invasive solution.