Skip to Main Content

++

Open Common Bile Duct Exploration

++

  • Clearance of biliary obstruction due to calculus disease if endoscopic techniques (eg, endoscopic retrograde cholangiopancreatography) are unavailable, have failed, or are not feasible due to patient anatomy or status.

++

Transduodenal Sphincteroplasty

++

  • Impacted stone at the ampulla of Vater.
  • Previous attempt at common bile duct exploration.
  • Most often performed at the time of cholecystectomy when common bile duct exploration has failed to clear a stone impacted in the distal common bile duct.

++

Choledochoduodenostomy

++

  • Unresectable malignant distal common bile duct obstruction, as a palliative procedure.
  • Benign strictures of the distal common bile duct.
  • Salvage drainage procedure in the presence of large primary stones or numerous stones in the distal common bile duct.

++

Open Common Bile Duct Exploration

++

Absolute

++

  • None.

++

Relative

++

  • Previous biliary bypass.

++

Transduodenal Sphincteroplasty

++

Absolute

++

  • None.

++

Relative

++

  • Fibrotic ampulla.
  • Inability to pass a 3-mm probe through the ampulla.
  • Abnormal-appearing ampulloduodenal junction on cholangiography.
  • Common bile duct diameter > 2 cm.
  • Long common bile duct stricture.

++

Choledochoduodenostomy

++

Absolute

++

  • Duodenal obstruction.

++

Relative

++

  • Primary resection of the obstructing lesion or clearance of the obstructing calculi.
  • Nondilated bile duct.
  • Proximal duodenal inflammation.
  • Potential duodenal obstruction.
  • Sclerosing cholangitis.

++

Open Common Bile Duct Exploration

++

Expected Benefits

++

  • Removal of the stone (or stones) from the common bile duct.
  • Prevention of cholangitis and cholestatic liver injury.

++

Potential Risks

++

  • Bleeding requiring transfusion or reoperation.
  • Retained bile duct stones requiring prolonged T-tube drainage, additional procedures by interventional radiology, or possible additional surgical intervention.
  • Bile leak requiring prolonged T-tube drainage.
  • Iatrogenic injury to the biliary tree or duodenum.
  • Surgical site infection requiring drainage or antibiotics.

++

Transduodenal Sphincteroplasty

++

Expected Benefits

++

  • Removal of the stone (or stones) from the distal common bile duct.
  • Prevention of cholangitis and cholestatic liver injury.

++

Potential Risks

++

  • Bleeding requiring transfusion or reoperation.
  • Bile leak requiring prolonged drainage, drain placement, or reoperation.
  • Duodenal leak.
  • Iatrogenic injury to the bile duct or duodenum.
  • Pancreatitis.
  • Biliary stricture.
  • Surgical site infection requiring incision and drainage or antibiotics.

++

Choledochoduodenostomy

++

Expected Benefits

++

  • Restoration of enteric biliary drainage.
  • Prevention of cholangitis and cholestatic liver disease.

++

Potential Risks

++

  • Bleeding requiring transfusion or reoperation.
  • Bile leak requiring prolonged drainage, drain placement, or reoperation.
  • Surgical site infection requiring drainage or antibiotics.
  • Conversion to choledochojejunostomy if choledochoduodenostomy cannot be performed.

++

Open Common Bile Duct ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.