OPEN CHOLECYSTECTOMY WITH COMMON BILE DUCT EXPLORATION WITH CHOLEDOCHODUODENOSTOMY

     Gall stones with several bile duct stones and a moderate to well-dilated common bile duct are an indication for this surgery. Sometimes bile duct will be packed with stones and in these patients, there is a tendency for recurrence of bile duct stones even after removing the stones from bile duct and also removal the gallbladder. So, to prevent the recurrence of bile duct stone formation (primary bile duct stones), the Common bile duct is joined with first part of duodenum.  By performing this treatment, any recurring bile duct stones will travel via this bypass section into the duodenum.

     Once decided to do this procedure, patient is prepared for general anaesthesia. After giving anaesthesia, abdomen is opened through right subcostal incision. Gall bladder and bile duct junction area is dissected and bile duct will be exposed. Gall bladder removal will be completed. After this the common bile duct will be opened vertically for a distance of 1.5 to 2.0cm. All stones that present in the bile duct will be removed.

     Common bile duct will be washed with normal saline to remove all the infected material and debris.  Then the first part of the duodenum is opened transversely and the bile duct is joined with the duodenum with interrupted sutures. This definitely, make an alternate communication between the bile duct and the duodenum. Also, in case of any stone recurrence in future, these stones will pass to the duodenum through this newly created passage.

     This procedure is mainly recommended for recurrent bile duct stones and multiple bile duct stones with medium to gross dilatation of bile duct. 

Sump Syndrome

     Sump syndrome is presence of stones or sludge in the lower common bile duct which comes after choledochoduodenostomy.

     After choledochoduodenostomy, bile reaches the duodenum through the anastomotic area and there will be stagnation of bile at lower CBD and leads to formation of sludge or stones. This can present with pain with or without features of infection.

     Diagnosis is made by MRCP. Treatment is Endoscopic retrograde cholangiography along with biliary sphincterotomy and stone/sludge extraction.