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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