Professional Documents
Culture Documents
1. With common bile duct stone identified fluoroscopically and if the stones in
the duct are small, they may sometimes be flushed into the duodenum with
saline irrigation via the cholangiography catheter after the sphincter of Oddi
has been relaxed with glucagon.
2. If this technique fails to remove the stone, a balloon catheter or wire basket
can be passed via the cystic duct and down the common bile duct, where it
is inflated and withdrawn to attempt stone extraction.
3. If still unsuccessful, flexible choledochoscopy is indicated.
The two common approaches to explore the common bile duct for stone removal
includes:
Transcystic approach
Via choledochotomy
Transcystic approach
At the completion of the cholangiography, a wire is fed down the cystic duct
into the common bile duct. Through a Seldinger technique or use of a balloon
catheter, the cystic duct is gently dilated to
allow passage of flexible choledochoscope. With
the surgeon feeding the choledochoscope into
the cystic duct and the assistant adjusting the
tip of the scope, the flexible choledochoscope
is advanced into the distal bile duct. With
identification of the offending stone, a wire
basket is passed to ensnare the stone,
withdrawing it and the choledochoscope
together.
Choledochotomy approach
Contraindication: