Bile Duct Exploration

Laparoscopic trans-cystic exploration of the common bile duct

This is a laparoscopic or keyhole technique used to extract stones from the common bile duct without resorting to open operation.

The cystic duct is opened at the time of laparoscopic cholecystectomy and a balloon passed into the duct to dilate it gently. A dormier basket is passed into the common bile duct and under fluoroscopic guidance bile duct stones are snared and extracted. If the cystic duct is wide a choledochoscope (flexible telescope for inspecting the bile duct) is passed into the biliary tree and stones snared under direct vision. If a stone is impacted at the bottom of the common bile duct and cannot be engaged and removed then a wire may be passed into the duodenum and a short stent deployed to cross the ampulla of Vater so that the bile duct drains into the duodenum. The ampulla of Vater is the sphincter at the bottom of the bile and pancreatic ducts where they enter the duodenum. Therefore the cystic duct may be closed and the operation concluded. Post-operatively and ERCP may be performed to remove the stent and perform a sphincterotomy.

Formal laparoscopic exploration of the common bile duct

This is a laparoscopic technique used to extract stones from the common bile duct without resorting to open operation.

For a large stone in a dilated duct a transcystic exploration may not be possible at the time of laparoscopic cholecystectomy. Instead the common bile duct is opened directly and a dormier basket is passed into the common bile duct. Under fluoroscopic guidance any bile duct stone is snared and extracted. Again a choledochoscope may be passed in to the biliary tree and stones snared under direct vision. Thereafter the opening in the bile duct is closed and the operation concluded.

If a stone is impacted at the bottom of the common bile duct and cannot be engaged to be removed then a wire may be passed into the duodenum and a short stent deployed to cross the ampulla of Vater so that the bile duct drains into the duodenum. Thereafter the opening in the bile duct is closed and the operation concluded. Post-operatively an ERCP may be performed to remove the stent.