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Choledochotomy is a surgical incision made directly into the common bile duct. It is most commonly performed during common bile duct exploration when stones need to be removed and a transcystic approach is not suitable or has failed. A choledochoscope can be passed through the opening to inspect the duct and retrieve stones. After exploration, the duct can be closed primarily or managed with drainage such as a T-tube in selected cases.
read more about choledochotomy ...The procedure is used for selected patients with common bile duct stones that require operative exploration. It can be considered when stones are large, numerous, impacted, located unfavorably for transcystic removal, or not cleared by endoscopic treatment. Endoscopic retrograde cholangiopancreatography remains a common treatment for choledocholithiasis, so choledochotomy is not required for every bile duct stone. Duct diameter, inflammation, stone burden, anatomy, available expertise, and the need for concurrent gallbladder surgery influence the approach.
The surgeon exposes the common bile duct and makes a controlled longitudinal incision in its anterior wall. A choledochoscope, irrigation, baskets, balloons, or graspers can be used to inspect the biliary tree and remove stones. The duct is checked for retained stones and free drainage before the incision is closed. Primary sutured closure is used in suitable patients, while a T-tube or another drainage strategy can be chosen when the surgeon wants postoperative decompression or access.
Recovery depends on whether the procedure is laparoscopic or open and whether cholecystectomy or another biliary operation is performed at the same time. Patients are monitored for abdominal pain, fever, jaundice, bile leakage, bleeding, pancreatitis, and liver-test abnormalities. A T-tube, when used, requires external care and is removed only after the biliary tract has been assessed and drainage is considered safe. Diet and activity are advanced as gastrointestinal function and postoperative symptoms improve.
Possible complications include bile leak, bleeding, infection, cholangitis, pancreatitis, retained stones, and narrowing of the common bile duct. A bile leak can produce an intra-abdominal collection or bile peritonitis and can require drainage or endoscopic treatment. T-tube use adds risks such as dislodgement, infection, fluid and electrolyte loss, or leakage after removal. Recurrent bile duct stones can develop later and can require endoscopic or repeat surgical treatment.
The surgeon makes an incision in the common bile duct to gain direct access to the biliary tree.
It creates a direct route for choledochoscopy and stone extraction when stones cannot be removed reliably through the cystic duct or by another approach.
No. Many suitable ducts can be closed primarily after stone clearance, while T-tube drainage is reserved for selected situations.
Yes. Retained or recurrent stones are possible, which is why the duct is inspected during surgery and follow-up treatment can be needed if obstruction returns.
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