Cholecystectomy with exploration of common duct; with transduodenal sphincterotomy or sphincteroplasty, with or without cholangiography
CPT4 code
Name of the Procedure:
Cholecystectomy with Exploration of Common Duct; Transduodenal Sphincterotomy or Sphincteroplasty, with or without Cholangiography (Commonly known as Gallbladder Removal Surgery with Bile Duct Exploration and Sphincter Repair)
Summary
This surgical procedure involves removing the gallbladder, exploring the bile duct for stones or other obstructions, and performing a sphincterotomy or sphincteroplasty to ensure proper bile flow. Sometimes, a cholangiography (an imaging test) is done during the procedure to visualize the bile ducts.
Purpose
The procedure addresses conditions like gallstones, bile duct stones, infections, or tumors that block bile flow. The goal is to relieve pain, treat infection, and ensure the normal flow of bile from the liver to the intestine.
Indications
- Recurrent gallstones causing pain or infection
- Bile duct obstructions
- Pancreatitis caused by bile duct stones
- Jaundice (yellowing of the skin and eyes)
- Cholangitis (bile duct infection)
- History of gallbladder problems unresolvable by less invasive treatments
Preparation
Patients are generally required to fast for at least 8 hours before the procedure. Medications, especially blood thinners, may need to be adjusted. Diagnostic tests such as blood work, ultrasound, or MRI might be performed to assess the gallbladder and bile ducts.
Procedure Description
- The patient is placed under general anesthesia.
- The surgeon makes small incisions to insert a laparoscope and surgical instruments.
- The gallbladder is identified and safely removed.
- The common bile duct is explored for stones or obstructions.
- A transduodenal sphincterotomy or sphincteroplasty is performed to improve bile flow.
- A cholangiography may be done to visualize the bile ducts.
- Once all obstructions are removed, the incisions are closed.
Tools and equipment include laparoscopes, surgical instruments, and imaging devices for cholangiography. General anesthesia is administered for the patient's comfort and immobility.
Duration
The procedure typically takes 2 to 3 hours.
Setting
The surgery is usually performed in a hospital operating room.
Personnel
The team includes a surgeon, an anesthesiologist, scrub and circulating nurses, and possibly a radiologist if cholangiography is performed.
Risks and Complications
Common risks include infection, bleeding, and adverse reactions to anesthesia. Rare complications may involve bile duct injury, bile leaks, pancreatitis, or blood clots. Management of complications depends on their nature and severity.
Benefits
The primary benefits are pain relief, resolution of infection, and restored bile flow, often realized immediately or within days after surgery.
Recovery
Post-operative care includes monitoring in the recovery room, pain management, and instructions on wound care. Most patients can go home within a day or two and return to normal activities in 1-2 weeks. Follow-up appointments are usually scheduled to check for complications and ensure proper healing.
Alternatives
- Non-surgical management of symptoms with medication
- Endoscopic retrograde cholangiopancreatography (ERCP) to remove ductal stones
- Percutaneous cholecystostomy for drainage in high-risk patients Each alternative has its own pros and cons, typically involving less immediate risk but potentially less definitive treatment.
Patient Experience
Patients will be under general anesthesia during the surgery, so they will not be conscious. Post-surgery, some discomfort or pain at the incision sites is common, which can be managed with pain medications. Most patients experience significant relief from previous symptoms following recovery.