47612 Cholecystectomy with exploration of common duct; with choledochoenterostomy

Name of the Procedure:

Cholecystectomy with exploration of the common duct; with choledochoenterostomy (commonly known as gallbladder removal with bile duct exploration and bile duct-to-intestine surgical connection).

Summary

In layman's terms, this procedure involves the removal of the gallbladder and a thorough examination of the common bile duct to remove any blockages or stones. Additionally, it creates a new pathway for bile to flow directly from the bile duct into the intestines.

Purpose

The procedure addresses conditions like gallstones, bile duct stones, or strictures which cause pain, infection, or jaundice. The goal is to alleviate symptoms, prevent complications from blockages, and ensure proper drainage of bile from the liver to the intestines.

Indications

• Recurrent gallstones or bile duct stones
• Chronic or acute cholecystitis (gallbladder inflammation)
• Bile duct strictures or blockages
• Pancreatitis due to gallstones
• Biliary dyskinesia (impaired bile flow)

Preparation

• Fasting for 8-12 hours prior to surgery.
• Adjustments to medications, especially blood thinners.
• Preoperative blood tests, imaging (like ultrasound or MRCP), and possibly an ERCP (endoscopic retrograde cholangiopancreatography).

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A small incision is made in the abdomen.
3. Gallbladder Removal: The gallbladder is carefully dissected and removed.
4. Common Duct Exploration: The common bile duct is explored for stones or blockages, often using a cholangiogram (contrast dye X-ray).
5. Choledochoenterostomy: A connection (anastomosis) is made between the common bile duct and the intestine (usually the duodenum or jejunum) to ensure bile flow.
6. Closure: The incision is closed, and the patient is taken to the recovery area.

Duration

The procedure typically takes 2-4 hours, depending on complexity.

Setting

The procedure is performed in a hospital's surgical facility.

Personnel

• Surgeon (specializing in gastrointestinal or hepatic surgery)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, and reaction to anesthesia.
• Rare risks: Bile leakage, injury to nearby organs, blood clots, and persistent bile duct strictures.

Benefits

• Relief from pain, infections, and jaundice.
• Prevention of future bile duct complications.
• Improved quality of life and digestion post-recovery.

Recovery

• Hospital stay for 2-5 days post-surgery.
• Pain management with prescribed medications.
• Gradual return to normal diet; starting with clear liquids.
• Restriction on heavy lifting or strenuous activities for 4-6 weeks.
• Follow-up appointments to monitor healing and bile flow function.

Alternatives

• ERCP with stone removal (less invasive, but may not be suitable for all cases).
• Medication to dissolve gallstones (rarely effective for larger stones or severe cases).
• Watchful waiting with dietary adjustments, if symptoms are mild.

Patient Experience

During the procedure, the patient will be under general anesthesia and feel no pain. Post-surgery, there may be pain or discomfort at the incision site, managed with pain relief medications. Most patients experience significant symptom relief within a few weeks and can return to their usual activities, following the surgeon’s recovery guidelines.