47420 Choledochotomy or choledochostomy with exploration, drainage, or removal of calculus, with or without cholecystotomy; without transduodenal sphincterotomy or sphincteroplasty

Name of the Procedure:

Choledochotomy or Choledochostomy with Exploration, Drainage, or Removal of Calculus, with or without Cholecystotomy; without Transduodenal Sphincterotomy or Sphincteroplasty

Summary

A choledochotomy or choledochostomy is a surgical procedure to explore the common bile duct, drain it, or remove gallstones. This procedure may involve making an incision in the bile duct and does not require cutting through the duodenum or reshaping the sphincter muscle.

Purpose

This procedure is used to address obstructions in the bile duct caused by gallstones (calculi). The goal is to relieve the blockage, drain any infections, and remove the stones to restore normal bile flow.

Indications

• Persistent bile duct obstruction
• Recurrent biliary infections or cholangitis
• Symptomatic gallstones not amenable to less invasive treatments
• Jaundice caused by bile duct blockage
• Pancreatitis secondary to bile duct obstruction

Preparation

• Fasting for at least 8 hours prior to surgery
• Preoperative imaging studies (e.g., ultrasound, MRCP)
• Blood tests to evaluate liver function and clotting parameters
• Possible administration of antibiotics to prevent infection

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the abdomen to access the common bile duct.
3. The surgeon explores the duct to locate the stones or obstruction.
4. The bile duct is incised (choledochotomy) or opened (choledochostomy), and stones are removed or the duct is drained.
5. The bile duct and incision are closed, sometimes inserting a temporary drainage tube.
6. The cholecystotomy (incision into the gallbladder) may be performed if required.
7. The abdominal incision is sutured closed.

Duration

The procedure typically takes 1-3 hours, depending on complexity and patient condition.

Setting

Performed in a hospital operating room.

Personnel

• General Surgeon or Hepatobiliary Surgeon
• Anesthesiologist
• Surgical Nurse
• Operating Room Technician

Risks and Complications

• Infection at the surgical site
• Bile leakage
• Bleeding
• Injury to surrounding organs or bile ducts
• Anesthesia-related complications
• Biliary stricture formation

Benefits

• Relieves symptoms of bile duct obstruction
• Prevents recurrence of infections and jaundice
• Allows normal bile flow, improving digestion and liver function
• Expected to improve symptoms almost immediately, though full recovery may take weeks

Recovery

• Hospital stay for 3-7 days post-surgery
• Pain management with medications
• Gradual increase in activity as tolerated
• Follow-up imaging and blood tests to ensure normal bile flow
• Restrictions on heavy lifting and strenuous activities for several weeks
• Close monitoring for signs of infection or complications

Alternatives

• Endoscopic Retrograde Cholangiopancreatography (ERCP) with stone removal
• Percutaneous Transhepatic Cholangiography (PTC) for drainage
• Non-surgical management with medications, though less effective

Patient Experience

• Initial pain and discomfort managed by painkillers
• Possible nausea and limited appetite post-surgery
• Gradual improvement in symptoms of obstruction and infection
• Close follow-up with the surgical team for several months