Open CBD Exploration
- Perform an extensive Kocher maneuver such that the area of the ampulla can be palpated.
- Make a distal, vertical, supraduodenal choledochotomy approximately 1.5 cm in length.
- Pass Fogarty catheters superiorly to extract stones from the common hepatic duct and inferiorly through the ampulla to extract CBD stones.
- Irrigate generously with saline.
- Ensure that the CBD is clear of stones using either choledochoscopy or a cholangiogram.
- Close the duct primarily or over a T tube at least 14F in size.
- Completion cholangiogram.