腹腔镜再次胆总管探查取石治疗全腹内脏反位胆总管结石一例OA

To report a case of recurrent choledocholithiasis with situs inversus totalis managed by laparoscopic reoperative common bile duct exploration combined with choledochoscopy,and to discuss the key surgical techniques and perioperative considerations.The patient was a 62-year-old woman with a 20-year history of recurrent epigastric pain,recently exacerbated for 2 days.The patient had undergone open cholecystectomy and common bile duct exploration with T-tube drainage 40 years ago for cholecystolithiasis and choledocholithiasis,and experienced a recurrence managed conservatively 20 years ago.Preoperative imaging including computed tomography,magnetic resonance cholangiopancreatography,and endoscopic ultrasonography confirmed multiple choledocholithiasis and situs inversus totalis.After multidisciplinary team evaluation,the patient received laparoscopic reoperative common bile duct exploration with choledochoscopic stone extraction and T-tube drainage.Key operative steps included adhesiolysis of dense intra-abdominal adhesions,anatomical exposure of the common bile duct,choledochotomy with stone extraction,choledochoscopic examination,and T-tube placement.The operation lasted 110 minutes with an estimated blood loss of 10 mL.No postoperative complications such as hemorrhage,bile leakage,or intra-abdominal infection occurred.The patient was discharged on postoperative day 5.Follow-up choledochoscopy at 2 months postoperatively showed no residual or recurrent stones,and the T-tube was removed.The patient remained asymptomatic at the 15-month follow-up.In conclusion,laparoscopic reoperative common bile duct exploration combined with choledochoscopy is a feasible and safe option for patients with situs inversus totalis and recurrent choledocholithiasis.Successful outcome depends on thorough preoperative planning utilizing previous imaging and surgical records,multidisciplinary assessment,meticulous laparoscopic adhesiolysis and exposure of the common bile duct to avoid injury,and vigilant postoperative monitoring for complications and wound healing.