Bhandarkar S, Dotor N, Bendapudi N, Kamat N, Parekh S, Vora S, Maydeo A. Transcystic laparoscopic common bile duct stone clearance facilitated by intraoperative fluoroscopy guided cholangiography: A case report. World J Surg Proced 2026; 16(2): 122292 [DOI: 10.5412/wjsp.122292]
Corresponding Author of This Article
Sanil Parekh, Additional Professor, Consultant, Institute of Gastrosciences, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, Mumbai 400004, Mahārāshtra, India. sanilparekh.sp@gmail.com
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Surgery
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case-report
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Bhandarkar S, Dotor N, Bendapudi N, Kamat N, Parekh S, Vora S, Maydeo A. Transcystic laparoscopic common bile duct stone clearance facilitated by intraoperative fluoroscopy guided cholangiography: A case report. World J Surg Proced 2026; 16(2): 122292 [DOI: 10.5412/wjsp.122292]
Sanatan Bhandarkar, Nilesh Dotor, Nayan Bendapudi, Department of General and Minimal Access Surgery, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai 400004, Mahārāshtra, India
Nagesh Kamat, Sanil Parekh, Sehajad Vora, Amit Maydeo, Institute of Gastrosciences, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai 400004, Mahārāshtra, India
Author contributions: Kamat N wrote the manuscript; Bhandarkar S, Dotor N, Bendapudi N, Maydeo A, and Vora S were involved in the procedure; Parekh S, Dotor N, and Maydeo A were involved in the clinical management; All authors were involved in the preparation and approved the final version of the manuscript.
AI contribution statement: AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Informed consent statement: Written Informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Sanil Parekh, Additional Professor, Consultant, Institute of Gastrosciences, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, Mumbai 400004, Mahārāshtra, India. sanilparekh.sp@gmail.com
Received: April 15, 2026 Revised: May 12, 2026 Accepted: June 8, 2026 Published online: September 16, 2026 Processing time: 154 Days and 14.9 Hours
Abstract
BACKGROUND
Laparoscopic cholecystectomy combined with management of choledocholithiasis can present with several challenges, particularly when attempting single-stage clearance.
CASE SUMMARY
An 83-year-old male presented with right subcostal pain of 4 days’ duration. Magnetic resonance cholangiopancreatography showed cholelithiasis, choledocholithiasis, and cholecystitis. Endoscopy showed fibrotic narrowing in the duodenum. The stricture was dilated with a controlled radial expansion balloon up to 14 mm post, allowing a gastroscope to be passed, but a duodenoscope could not be negotiated. The patient underwent a laparoscopic cholecystectomy. Calot’s triangle was dissected, and the cystic artery was clipped and cut. Cystic ductotomy was performed. The cystic duct was milked to remove sludge. Under fluoroscopic guidance with laparoscopic handling, the cystic duct was cannulated using a 5 Fr infant feeding tube over a 0.032" Terumo guide wire. Cholangiogram (Urografin 76%) showed a distal common bile duct filling defect suggestive of a stone. Ampulla was dilated up to 8 mm with a Hurricane RX - biliary balloon dilatation catheter. A stone extraction balloon was used to push the stone into the duodenum. Saline was flushed through the infant feeding tube till all the contents were washed away. The check cholangiogram showed no filling defect. The cystic duct was clipped and cut distal to the ductotomy. Hemostasis was achieved, and subcutaneous skin closure was done with monocryl.
CONCLUSION
The technique demonstrated adequate stone clearance with smooth postoperative recovery, highlighting its effectiveness and safety.
Core Tip: This case demonstrates a safe and effective single-stage laparoscopic transcystic clearance of a common bile duct (CBD) stone in an 83-year-old high-risk patient with concomitant cholelithiasis, choledocholithiasis, and acute cholecystitis, for whom conventional endoscopic retrograde cholangiopancreatography was not feasible due to a tight fibrotic duodenal stricture. The procedure avoided choledochotomy, resulted in smooth postoperative recovery, and highlights transcystic CBD exploration as a valuable minimally invasive alternative when endoscopic access is limited.
