CBD Stones

Question 1

What percentage of patients may pass common bile duct stones spontaneously without intervention?

Answer 1

~30%

Question 2

What signs suggest choledhocholithiasis pre-operatively?

Answer 2

enlarged CBD on ultrasound, imaging of a CBD stone on US, biliary pancreatitis, elevated AST, ALT, LDH, and Bili

Question 3

What are the published morbidity/mortality rates for ERCP

Answer 3

5-15% morbidity; 0-2% mortality rate

Question 4

What structures should be visualized for an adequate intra-operative cholangiogram?

Answer 4

Common Bile Duct, Smooth taper into duodenum, Right and Left Hepatic Duct

Question 5

Which drug helps to spasm/relax the sphincter of Oddi?

Answer 5

morphine/glucagon

Question 6

What instruments are essential of common bile duct exploration is required?

Answer 6

choledochoscope, helical stone baskets, biliary balloon catheters, syringes, fluoroscopy

Question 7

What are the most common complications of laparoscopic CBD exploration?

Answer 7

cystic duct stump leaks, pancreatitis, bile duct injury, bile duct stricture

Question 8

What percentage of patients fail clearance of CBD by post-operative ERCP

Answer 8

5-10%

Question 9

T/F If the patient has a small CBD (<5mm) CBD exploration should be avoided as small stones will likely pass spontaneously OR the surgeon can proceed with postoperative ERCP

Answer 9

TRUE

Question 10

At what locations are stay sutures placed for open/laparoscopic CBD exploration?

Answer 10

3 o’clock and 9 o’clock

Question 11

Why should T-tubes not traverse the ampulla into the duodenum?

Answer 11

This can cause pancreatitis

Question 12

What are options if an impacted stone is encountered?

Answer 12

Lithotripsy, duodenotomy and sphincteroplasty