Cholecystectomy with exploration of common duct
CPT4 code
Name of the Procedure:
Cholecystectomy with Exploration of Common Duct
Common Names: Gallbladder removal with bile duct exploration, Choledocholithotomy
Summary
Cholecystectomy with exploration of the common duct is a surgical procedure to remove the gallbladder and inspect the bile duct for stones, obstructions, or other issues. This can involve either a laparoscopic or open surgical approach.
Purpose
This procedure is performed to address gallstones, bile duct obstructions, infections, and sometimes cancers that affect the biliary tract. It aims to relieve symptoms such as pain, jaundice, and inflammation, and to prevent complications like pancreatitis or cholangitis.
Indications
- Gallstones causing pain or infection (cholecystitis)
- Jaundice due to bile duct blockage
- Pancreatitis caused by gallstones
- Suspected or confirmed bile duct stones (choledocholithiasis)
- Biliary dyskinesia or other functional biliary disorders
Preparation
- Fasting for at least 8 hours prior to surgery
- Possible adjustment or cessation of certain medications (e.g., blood thinners)
- Preoperative diagnostic tests such as blood work, ultrasound, or MRCP (Magnetic Resonance Cholangiopancreatography)
- Preoperative consultation with the anesthesiologist
Procedure Description
- The patient is placed under general anesthesia.
- For laparoscopic cholecystectomy, small incisions are made in the abdomen. For open surgery, a larger incision is made.
- The surgeon removes the gallbladder.
- The common bile duct is explored using a cholangiogram or choledochoscope to check for stones or obstructions.
- Any stones found are removed, and the duct is flushed to ensure patency.
- The incisions are closed with sutures or staples, and sterile dressings are applied.
Duration
The procedure typically lasts between 1.5 to 3 hours, depending on complexity and method (laparoscopic or open).
Setting
The procedure is performed in a hospital or surgical center with appropriate facilities for general anesthesia and postoperative care.
Personnel
- General surgeon or specialist hepatobiliary surgeon
- Surgical nurses
- Anesthesiologist and anesthesia nurse
- Operating room technicians
Risks and Complications
- Infection at the incision site or internally
- Bleeding
- Injury to the bile duct, liver, or surrounding organs
- Bile leakage
- Blood clots
- Reaction to anesthesia
- Rarely, long-term digestive issues
Benefits
- Relief from pain and other symptoms
- Prevention of recurrent gallstone attacks
- Resolution of jaundice or pancreatitis caused by bile duct obstruction
- Improved quality of life
Recovery
- Hospital stay of 1-3 days post-surgery, depending on the procedure type
- Pain management with prescribed medications
- Gradual return to normal diet over a few days
- Avoidance of heavy lifting and strenuous activities for 4-6 weeks
- Follow-up appointment to monitor healing and remove sutures or staples if necessary
Alternatives
- Non-surgical management with dietary changes and medications
- ERCP (Endoscopic Retrograde Cholangiopancreatography) to remove bile duct stones without gallbladder removal
- Percutaneous transhepatic cholangiography (PTC) for bile duct drainage and stone removal
- Each alternative has its own risks and benefits and may not be suitable for all patients.
Patient Experience
Patients can expect to feel some pain and discomfort in the incision area post-surgery, managed with pain relief medications. Nausea from anesthesia may also occur. Most patients report significant improvement in symptoms within a few days, with full recovery taking a few weeks. Proper post-operative care and adherence to medical advice are crucial for a smooth recovery.