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CBD Stone Removal

Common bile duct or CBD stone removal is a type of procedure involving the gallbladder and bile duct system. Procedures involving CBD stone removal are caused by blockage from bile stones that formed in gallbladder. There are three typical procedures for bile duct removal: open surgery, endoscopic retrograde cholangio-pancreatography and lparoscopic common bile duct exploration. There is also the use of lithotripsy and chemical solvents to dissolve common bile ducts stones in cases where the gallbladder is not infected or diseased.

  1. Open Surgery

    • Common bile duct or CBD stone removal is a type of procedure.

      The open surgery option for common bile duct stone removal is the most invasive. This type of procedure requires an extended period of hospitalization and recovery. This typically involves a surgical procedure in which a 6-in. incision is made under the right ribs. The gallbladder is removed in this procedure. Considering the high risk associated with this procedure, it is only used in patients who are not eligible for a LCBDE or ERCP.

    Endoscopic Retrograde Cholangio-Pancreatography (ERCP)

    • There are two types of Laparoscopic surgery: transcystic and choledochotomy.

      This procedure for removing common bile duct stones involves removal through the mouth, throat, esophagus, stomach, duodenum and biliary system. This procedure does not involve any type of incisions. This surgery requires an Endoscopic specialist and has a 10 percent risk of the patient developing pancreatitis due to the procedure.

    Laparoscopic Common Bile Duct Exploration (LCBDE)

    • There are two types of Laparoscopic surgery: transcystic and choledochotomy. This procedure is often the most common performed and also has the lowest mortality rates. It also the least invasive and the patient has little chance of developing pancreatitis.

      Transcystic LCBDE involves the use of a video choledochoscope inserted into the cystic duct via a small incision in the abdomen. A nintinol stone basket passed through the working channel of the choledochoscope as saline pressure irrigation is engaged. The stone(s) located in the bile duct is then maneuvered under videoscopic guidance. This process requires no T-tubes or drains and can be performed as an outpatient procedure.

      Choledochotomy LCBDE is typically used for larger and/or multiple stones. It is also the preferred method in the case of cholangitis and/or a brittle cystic duct. The choledochoscope and catheter are inserted into the common bile duct via a multiple instrument guide while irrigation is being infused into the common bile duct. T-tubes are inserted to drain the biliary tree for extended periods. The blockage will be removed, and often the gallbladder itself will be removed during this surgery.

    Other Procedures

    • Lithotripsy or shock wave treatment involves the use of shock waves generated in water by lithotripters. The shock waves are directed into the specified area to break up the stones. This procedure is generally most effective against solitary stones, and runs the risk of inflaming the pancreas.

      Contact dissolution of gallstone removal involves the direct entry of a chemical solvent, usually methyl tertiary-butyl ether, via a catheter. The chemical solvent is removed from the body via the respiratory system and is most effective against cholesterol gallstones. Side effects of this process include vomiting, breathing problems and drowsiness.

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