Skip to Main Content

++
++
++
++
++
++
++
++
++
++
++
++

The decision to explore the common duct depends not only on the patient's preoperative history and laboratory examination but also on the anatomic findings by palpation and inspection at the time of open operation. The presence of jaundice or a recent history of jaundice is a strong indication for exploration of the common duct. The common duct is explored if there is, on palpation, a suspicion of a stone; if the common duct is thickened or dilated; if the cystic duct is sufficiently dilated to permit stones to pass into the common duct; if the head of the pancreas is thickened, suggesting a chronic pancreatitis; or if there are one or more very small stones in the gall-bladder or cystic duct, which, because of their size, could easily pass into the common duct. More than 15 percent of patients with cholelithiasis present indications for exploration of the common duct unless a routine cholangiogram through the cystic duct is clearly negative. In approximately one-third of the common ducts explored, one or more stones will be recovered. Figure 1 depicts schematically the more common locations of calculi.

++

In the past, significant time was spent improving hepatic function, as it was believed that anesthesia and surgery were very hazardous in the presence of significant jaundice. Obviously, any coagulopathy must be corrected with vitamin K and blood products, while antibiotics should be given for sepsis or cholangitis. Percutaneous transhepatic cholangiography (PTHC) with retrograde catheter placement for decompression has been largely replaced by endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy. This allows stone extraction or stent placement to relieve the obstruction. Additionally, tumors may be visualized, biopsied, or studied with endoluminal ultrasound. Accordingly, the principal indication for open exploration of the common duct is the inability to clear the common duct stones ...

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.