Laparoscopic Treatment of the Extrahepatic Biliary Duct Disease and Biliodigestive Anastomosis

The extrahepatic bile ducts are part of the biliary system. Since the diseases that concern such structures usually cause obstruction, they are defined as biliary strictures. They can be broadly classified as benign or malignant. The benign ones can be divided into lithogenic and non-lithogenic, the first being largely more frequent. Among the latter, iatrogenic causes are the most frequent. On the other hand, malignant usually results from cholangiocarcinoma and pancreatic adenocarcinoma. Regarding laparoscopic exploration of the common bile duct (CBD), stone removal ranges from 94% to 98% with low morbidity and a mortality rate of 0%. If a CBD injury is suspected intraoperatively, intraoperative cholangiography should be used to confirm the diagnosis. If the leak is from a very small CBD lesion, it may be amenable to conservative management with a Jackson–Pratt drain to achieve a controlled leak. In cases of limited injury, we advocate leaving a drain in place with a view to treating the injury conservatively with a biliary stent. In all other cases, definitive repair is achieved with hepaticojejunostomy or hepaticoduodenostomy. In other cases, several centers have attempted laparoscopic excision of choledochal cysts and have reported surgical outcomes in adult patients. Again, obstruction of the extrahepatic bile ducts from a malignant process presents both diagnostic and therapeutic challenges. It is a common problem, with as many as 70% of pancreatic cancer patients presenting with obstruction upon diagnosis. While most biliary cancer patients present when the disease is unresectable, the treatment of choice for early biliary cancers is surgical resection, even though the risk of recurrence is high. The surgical approaches, from completely open to laparoscopic or robotic choice, demonstrated some changing trends. There was a noticeable increase in the minimally invasive approach in biliary cancer procedures. However, the rate of increase has varied between the laparoscopic and the robotic-assisted approaches. The laparoscopic treatment of the common bile duct disorder, according to the type of biliary tract disease, is then diffusely described.