Transduodenal Sphincteroplasty
- Perform an extensive Kocher maneuver.
- Make a transverse or longitudinal duodenotomy on the lateral duodenal wall at the junction of the lower one-third and upper two-thirds of the duodenum.
- Identify the papilla.
- Cut the ampullary sphincter in the 11 o'clock position on the papilla using cautery or scissors. Extend this to include the entire common tract of the sphincter of Oddi.
- Extract all stones.
- Suture the wall of the CBD to the duodenal mucosa using interrupted fine absorbable sutures.
- Close the lateral duodenotomy.