Management

Preoperative management, when a dilated common bile duct (>8 mm) is seen or stones are detected on ultrasound, is ERCP with sphincterotomy and stone extraction. If this is successful and is free of complication, a laparoscopic cholecystectomy is performed in 24-48 hours. During the procedure, the common duct should be evaluated by intraoperative cholangiography. For patients who are debilitated or elderly, ERCP with sphincterotomy is sufficient and cholecystectomy does not have to be performed.

In up to 5% of patients undergoing cholecystectomy, common duct calculi are present without clinical abnormality to signal their preoperative detection. Use of intraoperative cholangiogram provides a road-map for the surgeon, identifies an anomalous cystic duct, and can detect ductal calculi. Many surgeons use intraoperative cholangiography selectively on only those patients with suspected duct stones or who have a dilated common duct while others use this routinely. Recall that 8% to 12% of patients with gall stones will have duct stones as well. Retrospective reviews have suggested that routine cholangiography has decreased negative explorations and overall morbidity of cholelithiasis.

When detected intraoperatively by cholangiography during laparoscopic cholecystectomy, there are several ways to approach stone extraction:

1. Transcystic common duct exploration and stone extraction using baskets, balloons, and/or the choledochoscope is successful 90-95% of the time as determined by completion cholangiography.

2. Laparoscopic choledochotomy with common duct exploration and T-tube placement can also be done in experienced hands. If after a repeat T-tube cholangiogram at 10-14 days shows no further stones, the T-tube can be removed. If a stone is still present, the T-tube is left in situ, then removed in 6 weeks when a tract has formed and stones may be removed via the tract.

3. If neither of the above are performed due to either the surgeon's inexperience or reluctance to leave a T-tube for patient comfort reasons , a postoperative ERCP can be relied upon to remove stones. However this exposes the patient to the morbidities of the procedure, and reoperation would be required if the ERCP were to fail.

4. Open common bile duct exploration with T-tube placement is the traditional method of management.

5. Duodenotomy and sphincterotomy or sphincteroplasty is occasionally needed to remove impacted stones.

Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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