Common Bile Duct Exploration

What is a common bile duct exploration?

The common bile duct is a tube that connects the liver, gallbladder, and pancreas to the small intestine. It drains fluids from the liver and pancreas to the small intestine to help digestion.

A common bile duct exploration is a procedure used to see if a stone is blocking the flow of bile from your liver and gallbladder to your intestine.

When is it used?

When a stone gets stuck in the common bile duct it may cause bile to back up into the liver. This causes jaundice. Jaundice is a condition in which the skin and the whites of the eyes become yellowish. If the stone is not removed, the common bile duct may become infected and need emergency surgery. It can also cause pancreatitis, an inflammatory reaction in the pancreas that can be life threatening. Common bile duct exploration is often done during surgery for removal of the gallbladder when the surgeon thinks there is a risk that a stone may have escaped into the common bile duct.

An alternative procedure is an endoscopic retrograde cholangiopancreatography (ERCP). When an ERCP is done, a slim, flexible, lighted tube called an endoscope scope is inserted into your mouth, down your throat, and through your stomach into the first part of the small intestine (duodenum). It is directed to the spot where the ducts of the biliary tree and pancreas open into the duodenum. Dye can be injected into the duct through a tube in the scope to look for stones with X-rays. If there are stones, a small cut is made in the intestine where the common duct enters it to allow the stone or stones to pass into the intestine. You should ask your healthcare provider about your choices for treatment.

How do I prepare for a common bile duct exploration?

Common bile duct surgery is often done as an emergency. If you and your surgeon can choose the time for surgery, then follow these instructions.

Plan for your care and recovery after the operation. Allow for time to rest and try to find people to help you with your day-to-day duties.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For these reasons, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. Aspirin, ibuprofen, or naproxen can cause extra bleeding during surgery. If you are taking daily aspirin for a medical condition, ask your provider if you need to stop taking it before your surgery.

Follow any other instructions your provider gives you. Eat a light meal, such as soup or salad, the night before the procedure. Do not eat or drink anything after midnight and the morning before the procedure. In some cases your healthcare provider says it is OK to have clear liquids up to 4 hours before the procedure.

What happens during the procedure?

You will be given general anesthesia. It will relax your muscles, put you to sleep, and prevent you from feeling pain during the operation.

Common bile duct exploration is usually done as part of an operation to remove the gallbladder. The procedure can be done with small cuts in your belly and a laparoscope or with a larger cut in your belly (“open surgery”). With either method, the surgeon will find and remove the gallbladder.

Your surgeon will open the common bile duct and remove any stones that can be seen or found with instruments. He or she will then inject dye into the duct to take an X-ray. This may show if there are more stones.

The surgeon will then insert a tube into the duct and connect the tube to a drainage bag so the bile can drain into the bag. Several days later you will have another X-ray to see if the duct is clear. If it is, the tube can be removed about 2 to 3 weeks later. If stones remain, a radiologist can use the tube site to try to remove the stones about 6 weeks after surgery.

What happens after the procedure?

You will be sore for a couple of weeks. You will have intravenous (IV) fluids during the first few days until your intestine starts working again. If you have a tube draining your common bile duct, you may stay in the hospital for 4 days or more. The tube may stay in place after you leave the hospital for 2 weeks or as long as several weeks. Follow your healthcare provider's instructions for gradually going back to your normal diet.

Avoid strenuous activity, such as lifting, for 4 to 6 weeks.

Ask your healthcare provider when you should come back for a checkup.

What are the benefits of this procedure?

Benefits of this procedure are:

• If stones were removed, you will no longer have the discomfort and danger of infection caused by a blocked duct.
• You will reduce the chance of liver damage caused by having jaundice for a long time.
• You will reduce the risk of inflammation of the pancreas (pancreatitis).

What are the risks associated with this procedure?

• There are some risks when you have general anesthesia. Discuss these risks with your healthcare provider.
• Swelling or scarring may damage the duct.
• Bile may leak from the duct.
• The surgeon may have to open your small intestine.
• You may develop an infection, and if the surgeon has to reopen the cut and insert a tube to allow the infection to drain, it may take longer to heal.
• You may have bleeding.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

After you have gone home from the hospital, call your provider right away if:

• You have abdominal pain.
• Your wound becomes red, warm, or very sore or starts to drain fluid.
• You develop nausea and vomiting.
• You develop a fever.

Call during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.