Cholecystectomy and Common Bile Duct Exploration

ABSTRACT

June 2005

Section 5 Gastrointestinal Tract and Abdomen

21 Cholecystectomy and Common Bile Duct Exploration

Gerald M. Fried, M.D., F.A.C.S.
McGill University Faculty of Medicine

Liane S. Feldman, M.D., F.A.C.S.
McGill University Faculty of Medicine

Dennis R. Klassen, M.D.
Dalhousie University Faculty of Medicine

The primary goal of cholecystectomy is removal of the gallbladder with minimal risk of injury to the bile ducts and surrounding structures. The authors describe an approach designed to maximize the safety of both routine and complicated cholecystectomies (including laparoscopic and open procedures) and discuss current indications and techniques for imaging and exploring the common bile duct (CBD). Preoperative evaluation involves collection of patient data (history, physical examination, imaging, and laboratory studies) and patient selection. Operative planning includes antibiotic and deep vein thrombosis prophylaxis and equipment selection. Operative technique is presented for laparoscopic cholecystectomy, laparoscopic CBD exploration, open cholecystectomy, and open CBD exploration. Troubleshooting considerations are addressed throughout. Intraoperative and postoperative complications are reviewed. Special consideration is given to conversion to laparotomy, acute cholecystitis, and choledocholithiasis. This chapter contains 86 bibliographic sources.