Common Bile Duct Exploration

Abstract

About 10–20% of patients with cholelithiasis present with choledocholithiasis. 1–2% of patients who undergo a cholecystectomy will present with retained stones postoperatively if intraoperative cholangiography is not done. Open common bile duct (CBD) exploration was the conventional method of stone extraction in the operating room; however, with the advent of laparoscopic surgery, newer options have been developed. CBD stones can present anywhere along a spectrum from silent (incidentally noted), to biliary colic, to obstruction of the ampulla of Vater, and all the way to obstructive jaundice and ascending cholangitis. There are two generally accepted ways to approach a CBD exploration to include transcystic or transcholedochal approaches. The approach used is dictated by stone size, location, and duct morphology. With either approach, completion cholangiography should always be done.