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from Section 17 - General Surgery
Published online by Cambridge University Press: 05 September 2013
Common bile duct exploration is indicated for radiologically confirmed or manually palpable gallstones in the common bile duct (choledocholithiasis). These stones can be asymptomatic or causing obstructive jaundice, gallstone pancreatitis, or ascending cholangitis. It is also indicated to diagnose and treat obstructive jaundice from a benign or malignant stricture; to diagnose and treat stenosis of the sphincter of Oddi; or to repair an injury caused by operation or trauma. Choledochotomy is also appropriate when there are no other alternatives to decompress the common bile duct.
When a stone is identified preoperatively, it is most effective to perform a preoperative ERCP (endoscopic retrograde cholangiopancreatogram) with sphincterotomy to allow extraction of, or access to, common bile duct stones. Patients with resolved cholangitis, persistent jaundice, unresolving pancreatitis, or common bile duct stones documented by other tests are ideal candidates for preoperative ERCP. For stable patients, ERCP may also be performed after cholecystectomy is performed. With the availability of ERCP, the need for open or laparoscopic exploration of the common bile duct has decreased significantly in recent years.
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