Friday, September 12, 2014

Common Bile Duct Exploration



Common Bile Duct Exploration
Objective
In case of:
•   To remove stone in secondary bile duct stones
•   To remove stone in primary bile duct stones.
Position
Supine.
Anesthesia
General.
Procedure
•   Incise peritoneum over common bile duct
•   Put 2 stay sutures on anterior wall
•   Aspirate bile from the duct and incise its anterior wall
•   Extract all stones using a Desjardin’s forceps or Fogarty’s catheter
•   Confirm patency of lower end of CBD by posing a red rubber catheter into the duodenum
•   Close the CBD over an appropriate size T-tube
•   Do a pre-op T-tube cholangiogram to rule out missed stones
•   Close wound in layers with sub-hepatic drainage. Bring T-tube out through a separate stab wound.
Instruments
•   General set
•   Biliary tract set
•   Gallstone probe (Fig. 9.22)
•   Desjardin’s gallstone forceps (Fig. 9.23)
•           Kehr T tube (Fig. 9.24)

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