Name of the Procedure:

Biliary Endoscopy, Intraoperative (Choledochoscopy)

Summary

Biliary endoscopy, also known as choledochoscopy, is a medical procedure performed during surgery to visualize and treat the bile ducts. It involves the use of a flexible scope to look inside the bile ducts for stones, blockages, or other abnormalities.

Purpose

Choledochoscopy addresses conditions such as gallstones, bile duct strictures, and infections. The primary goal is to diagnose and, often, treat issues within the bile ducts, ensuring they remain clear and functional.

Indications

• Presence of gallstones in the bile duct
• Unexplained jaundice (yellowing of the skin and eyes)
• Abnormal liver function tests suggesting bile duct issues
• Persistent upper abdominal pain with suspected biliary origin
• Biliary strictures or blockages
• Recurrent pancreatitis

Preparation

• Fasting for at least 8 hours before the procedure
• Adjustment or discontinuation of certain medications, as directed by the physician
• Pre-procedure blood tests, imaging studies, or other diagnostic assessments

Procedure Description

1. The patient is prepared and brought to the operating room.
2. General anesthesia or sedation is administered.
3. The surgeon makes an incision to access the bile ducts.
4. A flexible endoscope is inserted into the bile ducts through a small incision or through an existing surgical site.
5. The endoscope transmits live images to a monitor, allowing the surgeon to visually inspect the bile ducts.
6. If gallstones or other blockages are found, the surgeon may use special instruments passed through the endoscope to remove or treat them.
7. Upon completion, the endoscope is removed, and the incision is closed.

Duration

The procedure typically takes between 30 minutes to 1 hour, depending on the complexity of the situation.

Setting

Choledochoscopy is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon
• Surgical nurse
• Anesthesiologist
• Support staff, such as a surgical technologist

Risks and Complications

• Infection
• Bleeding
• Perforation of the bile duct or adjacent organs
• Adverse reactions to anesthesia
• Postoperative pain or discomfort

Benefits

• Accurate diagnosis and treatment of bile duct issues
• Relief from symptoms such as pain and jaundice
• Prevention of more serious complications like acute pancreatitis or cholangitis
• Results are usually immediate, with symptoms improving shortly after recovery

Recovery

• Hospital stay is usually brief, typically 1-2 days
• Follow post-operative care instructions, including wound care and activity restrictions
• Pain management with prescribed medications
• Follow-up appointments to monitor recovery and address any concerns

Alternatives

• Endoscopic Retrograde Cholangiopancreatography (ERCP): A less invasive procedure, but may not be feasible in all cases.
• Magnetic Resonance Cholangiopancreatography (MRCP): A non-invasive imaging technique, but only diagnostic.
• Open surgical exploration: More invasive with longer recovery.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, mild discomfort or pain may be experienced around the incision site, manageable with pain medication. Most patients can resume normal activities within a few weeks, with full recovery expected within a month.