Common Bile Duct Exploration is a surgery that involves opening the main bile duct that drains from your liver and gallbladder into the first part of the small intestine (called the duodenum). This is needed when a gallstone drops out of the gallbladder into the duct and partially or completely blocks up the duct. This can cause jaundice (yellowing of the skin and eyes), fever and chills, severe abdominal pain due to infection / inflammation of the bile duct, gallbladder or pancreas. This most often involves admission to the hospital and urgent intervention. Most commonly, a procedure called an ERCP is used to clear out the stones from the bile duct. If this is unsuccessful, drains may be placed through the skin into the bile ducts. Your gallbladder will have to be removed soon to prevent this potentially serious condition from occurring again.
During the operation to remove your gallbladder, if additional stones are found in the bile duct, you may need to have a duct exploration performed. This involves opening the duct directly and removing the stones.
Prior to Common Bile Duct Exploration surgery, you will be asked not to eat anything after midnight prior to your surgery. You will be given specific instructions from your surgeon or anesthesiologist about which medications you should or should not take prior to your surgery. You should not take any blood thinning medications at least 5 days prior to your operation. This should be discussed with your surgeon at your preop visit.
Postoperative Information
Common Bile Duct Exploration can be performed laparoscopically, though it often requires
a larger incision below your right rib cage. In the event that a larger incision or
open procedure is required, recovery time may be longer than the typical described
below.
Activity
You may resume activity gradually beginning shortly after surgery. You should begin
walking the night of surgery or the following morning and continue to increase as
you are able. Increased activity reduces the risk of blood clots, and improves breathing
to prevent pneumonia.
Avoid lifting more than 10 pounds for 2-4 weeks and excessive bending or twisting for 1-2 weeks following surgery. This is to allow healing of the incisions, specifically the fascia (the strongest layer of the abdomen wall) and decrease the risk of getting a hernia.
Avoid driving until you no longer need narcotic pain medication and you feel you can make rapid movements unimpaired by pain. Driving while taking narcotics can impair your ability to drive safely.
You should be able to return to work 1-2 weeks after surgery if you had laparoscopic surgery. For open surgery 2-4 weeks is typically required.
Wound Care
A small gauze and clear tape dressing is typically placed over each incision. These
dressings may be removed 48 hrs (2 days) after the operation. Below this dressing
are small brown or white pieces of tape (called Steri-Strips); these will fall off
on their own within 1-2 weeks or be removed at your follow-up visit with your surgeon.
If your surgeon gives you specific instructions other than this, please follow those
instructions.
If your surgery was done as an open procedure, you will probably have a long white dressing or gauze and tape dressing over your incision. This dressing may be removed 48-72 hrs (2-3 days) after the operation and will probably be removed before you leave the hospital. Your incision will probably be closed with small metal staples. These will be removed at your postop visit, usually 10-14 days after your operation.
You may shower after 48hrs (after the gauze and clear tape dressing is removed). It is okay to get soap and water on the incisions. Pat the area dry. It is not recommend that you submerge underwater (in a bathtub, pool, or hot-tub) for at least two weeks post-op.
After common bile duct exploration, a drain is often left in the common bile duct as it heals. If so, you will go home with this drain in most cases. It will be removed at the discretion of your surgeon when he/she feels the duct has adequately healed to safely remove the tube. It is critical that the tube is well protected from accidental removal, as removing the tube too early could result in infection and need for additional procedures or surgery.
If you notice drainage from your incisions, particularly if it is thick and foul-smelling or associated with a fever, contact your surgeon.
If you notice redness around your incisions, especially if it is getting worse or associated with drainage or a fever, contact your surgeon.
Medications - Pain Management
Pain is typically just around the site of incisions, but after laparoscopic surgery,
you may have more general abdominal pain or even shoulder pain due to the air used
to inflate your abdomen during the surgery. Pain from air inflation will go away in
24 to 48 hours.
Pain after an open operation can be significant. If you have an open surgery, you will most likely be placed on IV narcotics using a pump (PCA � patient controlled analgesia), which allows you to press a button for additional medication when you need it. This will be weaned off within a few days of your operation and you will start oral pain medications. It is very important that your pain be well controlled. Your pain should be controlled well enough for you to begin getting out of bed the morning after surgery and for you to perform deep breathing exercises. If you have pain that is not well enough controlled to allow you to walk or breathe deeply, talk to your surgery team. You may need to have your pain medications changed or increased.
You will be discharged with pain medication, typically a mild to moderate strength narcotic. Take as needed and as prescribed. You may also take over-the-counter medications such as Advil for pain. Most narcotic medications prescribed are combined with Tylenol (acetaminophen). Do not take additional Tylenol if you are taking a narcotic medication that already contains Tylenol.
Other Medications
You may be prescribed a stool softener when you go home. Pain medications can cause
constipation and a stool softener may help. You may also be given nausea medication
if you have experienced nausea or vomiting from taking your pain medication.
Home Medications
Unless otherwise instructed, you should be able to resume your usual home medications
the night of or the morning following your surgery.
Click here for more detailed information on commonly prescribed medications.
Diet & Bowel Care
You may resume your usual diet as you feel able unless otherwise instructed. You may
have some abdominal bloating or mild nausea after your operation, so eat slowly and
only what you can tolerate. Your appetite may be less than usual but typically returns
to normal within a week or two. Be sure to drink plenty of liquids (6-8 glasses of
water of juice each day) if your appetite is not very good.
Following Common Bile Duct Exploration, some people will develop loose stools or diarrhea. This is related to changes in your intestine's ability to absorb fatty foods. This will almost always get better on its own in 1-2 weeks, although you may need to avoid some foods, especially food high in fat. If this persists more than 2-3 months, talk to your surgeon; you may need medication to help control your symptoms.
Follow Up
You will be given a date and time to see your surgeon following surgery. If you are
discharged late in the day or over the weekend, you will be given a number to call
the following business day for an appointment. If you are having trouble making an
appointment, you should call your doctors' office directly for assistance.
Call Your Doctor If:
Contact Information
Daytime hours: Call 706-721-4686
After hours and weekends: Call 706-721-8400