In a remarkable accomplishment a team headed by Dr Rajiv Manek, Consultant Minimal Access Metabolic & Bariatric Surgeon comprising of Dr. Pratik Tibdewal, Consultant Gastroenterologist, Dr. Ashish Mishra, Consultant Interventional Cardiologist, Dr. Aniket Mule, Consultant Internal Medicine, Dr. Sanggita Checker, Consultant Pulmonologist, Dr. Roopa Mepani, Consultant Anaesthesiologist  Wockhardt Hospitals Mira Road, Mumbai, successfully removed 150 stones from a 60-year-old woman’s gallbladder. Some of these stones had slipped into her bile duct causing obstructive Jaundice (Choledocholithiasis).

Patient Mrs Shanti (name changed), a resident of Mira Road had 150 stones in her gallbladder for the past 10 years. She was aware of her condition but since the stones didn’t cause any problems, she didn’t seek medical help. All these years she managed with some dull pain because of the stones. The patient was obese, short neck, had hypertension, diabetes, bronchial asthma, and developed gallbladder infection when some of the stones slipped from the gall bladder into the bile duct leading to Acute infection of the Biliary system and Jaundice. The patient visited her family doctor who after initial investigations promptly suggested the patient visit Wockhardt Hospitals Mira Road which is a tertiary care center for further management.

Dr Rajiv Manek, Consultant Minimal Access Surgeon, Wockhardt Hospitals Mira Road, said, “On arrival in an emergency state, the patient exhibited symptoms such as severe upper abdominal pain radiating to the back, nausea and vomiting. Her eyes had turned yellow. I advised her to get admitted and quickly ran a few tests confirming her diagnosis of Acute Cholecystitis with Choledocholithiasis. We frequently see women aged 30 to 60 years present with symptomatic gallstones in OPD. However, Choledocholithiasis (the presence of stones within the common bile duct that is CBD) is a dreaded complication of long-standing gallstones. It caused jaundice, stomach pain, liver swelling & fever.

The liver produces bile which is a digestive juice. This bile is temporarily stored in the gallbladder. Gall bladder contracts during meals and this bile traverses the common bile duct to reach the duodenum (small intestine) where it aids digestion. Rarely stones from the Gallbladder slip into the Common Bile Duct leading to Obstructive jaundice and infection of the biliary tree. Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by Laparoscopic Gallbladder removal is the treatment of choice in these patients. However, due to complex anatomical challenges in this patient, the common bile duct could not be cannulated endoscopically and obstruction could not be relieved. Alternative approaches were discussed with the patient and the patient consented to the groundbreaking surgery which was performed using an innovative technique called Rendezvous Laparo-Endoscopic approach using Laparoscopic Transcystic Bile Duct cannulation with concurrent ERCP and CBD Clearance. The patient tolerated the procedure well and we could perform a single sitting Laparoscopic Cholecystectomy with Transcystic CBD cannulation, CBD Clearance, and CBD stenting using just 4 small punctures on her abdomen. She benefited from the advantages of Advanced Minimal Access and Key Hole Surgery resulting in faster recovery, minimal blood loss, and early return to work. After just 4 days of recovery, the patient was discharged and able to resume her normal daily activities without any complications.

Dr Manek added, “Laparo-Endoscopic Rendezvous technique is an effective salvage technique for difficult biliary cannulation. This decreases multiple exposure of the patient to general anesthesia.  The advantage is the concurrent removal of gallbladder stones using small punctures on the abdomen. The procedure lasts for an average of 90 minutes. It avoids multiple procedures for the patient and big abdominal scars. Not seeking timely treatment could lead to various complications like gallbladder perforation, gangrene of the gallbladder, sepsis, multi-organ failure, and risk to life.”

“I am thankful to the doctors for saving my life and helping me to get rid of the unbearable pain and improving the quality of life,” concluded patient Shanti (name changed).