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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