In order to explore, the common bile duct is opened via a longitudinal incision. An operative cholangiogram may be undertaken - this demonstrates the presence or absence of stones in the common bile duct.
Retrieval of stones is via a combination of:
The duct may be inspected using a choledochoscope. A sphincterotomy may be necessary to remove a stone impacted in the ampulla of Vater.
The common bile duct is closed over a T-tube which drains bile to the exterior. The main purpose of the T-tube is to allow access to the biliary tree for a further cholangiogram, usually about one week post-operatively.
Note that the use of ERCP and endoscopic sphincterotomy now provide a non-operative alternative for removal of stones in the common bile duct.
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