Utilization of Common Bile Duct Exploration in Benign Bile Duct Obstruction

Kenneth Gunawan1, Indah Jamtani2, Adianto Nugroho2*, Rofi Y. Saunar2, Aditomo

Widarso2, Taslim Poniman2

1. General Surgery resident, Department of Surgery, Faculty of Medicine

Universitas Indonesia – Cipto Mangunkusumo Hospital
2. Digestive Surgery Division, Department of Surgery, Fatmawati General
Central Hospital

*Corresponding author

Abstract

Background: In obstructive jaundice especially due to choledocholithiasis,

endoscopic retrograde cholangiopancreatography (ERCP) has been the mainstay of
diagnostic and treatment modality. However, in cases where ERCP is not feasible,
exploration of the common bile duct (CBD), followed by constructing a biliodigestive
bypass is the modality of choice. This study depicts the efficacy of CBD exploration
in Fatmawati General Central Hospital from 2018-2020.

Results: 210 participants with an equal distribution of gender (105 female, 105 male)
were enrolled in this study. The mean age for 2018, 2019, 2020 participants is
49.14±13.69 years, 47.19±12.36 years, 45.98±15.44 years, respectively. The cases
requiring CBD exploration in this study include choledocholithiasis (75,7%);
choledochal cyst (8,6%); biliary stricture (6,2%); cholangitis (4,7%); benign mass
(1,9%); bile leakage (1,9%); biliary stenosis (1,4%); hepatolithiasis (0,95%); and
Mirizzi syndrome (0,47%). The procedures conducted include CBD exploration
followed by choledochoduodenostomy (71%), roux-en-Y choledochojejunostomy
(29%), and T-tube placement (0,95%). It is shown that CBD exploration procedures
in Fatmawati Central General Hospital are all conducted by digestive surgeons.

Conclusion: In cases where ERCP is not feasible, CBD exploration followed by

biliodigestive bypass, depending on the indication, is a safe option.