Laparoscopic Biliodigestive  Bypass + Exploration of the Biliary Tract + Laparoscopic Cholecystectomy

Procedure Details

A 71-year-old patient presented to the emergency department with complaints of abdominal pain and general discomfort. Laboratory results indicated evidence of infection, with dissociated cholestasis and elevated liver enzymes, particularly alkaline phosphatase and GGT, with normal bilirubin levels. Ultrasound suggested acute cholecystitis due to gallstones with bile duct dilation. A magnetic resonance cholangiopancreatography (MRCP) was requested, ruling out choledocholithiasis but revealing distal tapering of the common bile duct at its junction with the ampulla of Vater near the head of the pancreas. This raised suspicion of a possible neoplastic process, although tumor markers were negative. Given the patient’s acute condition, surgical intervention via laparoscopy was decided upon.

During the laparoscopic exploration of the abdominal cavity, adhesions were dissected, followed by the commencement of cholecystectomy and exploration of the bile duct. A bile duct measuring nearly 2 cm in diameter, consistent with the findings of the MRCP, was discovered, containing abundant bile sludge. A biliodigestive bypass was performed through a lateral-to-lateral choledochoduodenostomy in a single plane using laparoscopic prolene sutures. The procedure was completed with laparoscopic cholecystectomy.