These calculi an generally large. The technical details of their removal will be given later.
EXTRACTION OF CALCULI FROM THE COMMON BILE DUCT THROUGH THE CYSTIC DUCT
ln patients with common hik ducts of normal caliber with one or two calculi within them, it is possible to attempt their extraction through the cystic duct to avoid having to perform cholcdochotomy in a narrow common bile duct. To perform this technique it is necessary the cystic duct be dilated or dilatablc. ln addition the common bile duct should coma in one or two calculi that are perfectly by means of operative cliolangiography.
Tbis technique cannot be performed when the duct joins the common bile duct in a very acute angle or when it runs parallel to the common bile duct, It will also be impossible to perform the removal of these calculi when the cystic duct joins the common bile duct on its inner border or on its anterior or posterior wall such as in cases where the cystic duct has a spiral tract. It is not advisable to use this rechruque if the common bile duel contains more than two calculi.
This technique should also not he attempted for the removal of calculi in the common hepatic duel or the intrahepatic ducts.
The calculi in rhc common bile duct arc removed by means of a fine malleable spoon. It is also possible lo explore the papilla by this method.
Once the calculus removed, a control operative cbolangiograrn is obtained through the cystic duct to prove that the common bile duct is free of calculi and that the passage of radiopaque substance into the duodenum is normal.
The urhor ulwavs uses a horizontal (transverse) choledochotomy, wlich prevents stenosis in a common bile dud of small diameter. Some authors perform the removal of calculi from common bile ducts of normal caliber through transduodenal sphinctcrotomy.