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Common Bile Duct Surgery and Choledochoduodenostomy
Video
Introduction
Approximately 15% of patients with gallbladder stones will also have stones within the common bile duct (CBD). Options for managing CBD stones include endoscopic treatment, including endoscopic retrograde cholangiopancreatography (ERCP) with biliary sphincterotomy, percutaneous interventions, and laparoscopic and open surgical procedures. Individual patient factors, available expertise, and desire for one- versus two-stage treatment will guide management strategy. Currently, the majority of patients with CBD stones are managed by using endoscopic techniques. However, endoscopic management of CBD stones may be problematic in patients with multiple large stones, stones above a stricture, and in patients with difficult access to the ampulla of Vater (stenosis, diverticulum, or altered anatomy, i.e., gastric bypass). Patients who are not candidates for endoscopic or percutaneous procedures may require surgical intervention. Surgical approaches to the CBD include laparoscopic CBD exploration through a transcystic approach or a choledochotomy, open CBD exploration, and biliary-enteric anastomosis.
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