A low-cost alternative for common bile duct exploration for the treatment of cholerocolitesis. Gallstones in the common bile duct may be asymptomatic, but may lead to complications such as acute cholangitis or acute pancreatitis. Among those patients with symptomatic cholerocolitesis, 10 to 20% have concomitant cholerocolitesis. Suspect cholerocolitesis if the patient has symptoms like abdominal pain, jaundice, and fever, elevate liver enzymes such as alkaline phosphatase or gamma-glutamyl transferase. The treatment depends on the clinical and patient characteristics, based on the SGA risk scale, low, intermediate, and high risk. This algorithm was taken for making decisions. For example, in high-risk patients, one option could be start with a cholecystectomy with a cholangiogram. If there are stones in the CVD, we do a laparoscopic exploration with cholangiogram or choleroscopy. If the stone is removed, we can continue with the cholecystectomy. However, if we do not resolve the cholerocolitesis, the following options is the open exploration post-ORCP, or we can perform ability bypass. Laparoscopic common bile duct exploration has been found to be a safe, efficient, and cost-effective treatment for cholerocolitesis. Following laparoscopic exploration, the clearance should be confirmed by a cholangiogram or a choleroscopy. Choleroscopy is an increasing valuable tool in diagnosis and treating complicated biliary diseases. The technique also improves the treatment outcome of difficult biliary stones. A 50-year-old male presents with a cramping pain in the right upper quadrant, jaundice, and fever. Significant history of positive smoking and alcoholism currently abandoned. Laboratory data show us liver function test with a cholestatic syndrome with total bilirubin of 15, direct bilirubin of 9, indirect bilirubin of 6, GGT of 560, and ALLP of 350. The hemogram shows a hemoglobin of 12, platelets count of 260, and white blood cells of 24, CI 99 of 67. The ultrasound report a dilated common bile duct of 15 millimeters, and a small gallbladder report a sclerotropic. A CT scan shows a dilation of both the hepatic ducts and the proximal bile duct of 17 millimeters. The rest of the bile duct is 12 millimeters, and a pretense nodular image of 10 millimeters in the pancreatic bile duct is seen. The diagnosis of cholelithiasis with high risk of cholerical lithiasis is made because the acute ascending choleritis grade 2 by Tokyo ERCP is performed with unsuccessful result, so an endobiliary prosthesis is placed and a sphincterotomy is made. We can see adhesions of the omentum to the gallbladder, classifying it as a difficult cholecystectomy Parkland IV. Adhesions are released with harmonic scalpel and blunt dissection. A cholangiogram is subsequently performed showing a dilated intra and extrapathic bile duct, with filling defect at the level of the intrapancreatic common bile duct, without passage of contrast to the duodenum. We continue with blunt dissection showing a dilated common bile duct, where a cholerocotomy is performed to insert a 10 millimeter endoscope. On cholangioscopy, we observe only one stone, and with the help of dormant basket, a stone is successfully removed. Primary clitical closure is performed with endoscopic suture with PDS 3-0. Subsequently, without being able to demonstrate the critical view of safety, a bilat procedure is performed without reconstituting cholecystectomy, Hahnemann V. When the procedure with no obvious complication, the patient is discharged after one day of hospital stay. The clinical implications we have is that the direct view of the CT to recognize and remove the stones is a good way to confirm the stone's clearance, avoid unnecessary use of T-tubes, and allow early recovery. As a conclusion, we can say that it is a technically repliable procedure and it allows low-income countries to access minimal invasive surgery procedures without the need for specific devices, and give the patient the best treatment available with low morbidity and mortality, provide effective management to the vast majority of the patients with clitical ETSs, even in the setting of large stones. It gives more cost-effective treatment for common mild duct stones.

cholerocolitesis

laparoscopic exploration

common bile duct stones

cost-effective treatment

cholangiogram