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Laparoscopic Bile Duct Exploration

This is an advanced laparoscopic procedure done for clearing of the stones blocking the bile duct.
What are CBD stones(common bile duct)?
The common bile duct is a tube which carries the bile produced in the liver to the intestine.The bile is an important digestive juice which helps in digesting fat.When stones form in the gallbladder or rarely in the bile duct itself they can block the free flow of bile.This can cause stagnation of the bile in the liver and later cause jaundice.Sometimes these stones can also obstruct the duct of the pancreas and cause life-threatening inflammation of the pancreas called acute pancreatitis.

How to diagnose CBD stones?
CBD stones are usually diagnosed with the help of blood tests and certain imaging modalities.
A liver function test is a blood test which can give a clue to the presence of bile duct stones.
An ultrasonography can diagnose the presence of bile duct stones in most cases.In doubtful cases and when further information is required an MRI scan called an MRCP can clearly define the presence of CBD stones.
How are CBD stones treated?
In most cases, CBD stones are cleared without surgery.This is done by a procedure called ERCP.Here an endoscope is passed into the mouth and into the intestine and the bile duct entered with a wire and the stones are pulled out.
In certain situations when the stones are very large or hard ERCP may fail.In such cases, a surgery is needed to clear the CBD stones.In the earlier times, this was done by opening the abdomen through a 15-20 cm long incision and opening the bile duct, clearing out the stones and closing it back.This is usually combined with a removal of the gallbladder also because the stones are usually produced in the gallbladder and slip into the bile duct.

What is Laparoscopic bile duct exploration?
In the recent years, most of the CBD stones which need surgery are treated laparoscopically.The advantage of this being a scarless operation with early recovery.Also, there is avoidance of problems of a regular operation like wound infection and hernia formation.
This procedure is best done in the hands of experienced laparoscopic surgeons.The laparoscopic ports are similar to a gall bladder operation with a few extra ports.
The surgeon uses a special endoscope called a choledocoscope which is inserted through the skin and the bile duct is cleared.
The patient recovers in a day or two and can be discharged early from the hospital.Compared to an open operation there is a minimal pain, minimal scar and early return to normal activities of life.

 

Authored By Dr G Parthasarathy - Surgical Gastroenterologist, Hyderabad