CPT® Code 47425

1. Indications

The choledochotomy or choledochostomy procedure, as described by CPT® Code 47425, is indicated for the following conditions:

• Acute Cholecystitis - This condition often necessitates surgical intervention due to inflammation of the gallbladder, particularly in critically ill patients who cannot undergo more definitive procedures.
• Biliary Obstruction - The presence of calculi (stones) in the common bile duct that obstruct bile flow is a primary reason for performing this procedure.
• Need for Exploration - When there is a suspicion of stones in the biliary system that require surgical exploration and removal.

2. Procedure

The procedure involves several critical steps to ensure effective exploration and management of the biliary system:

• Step 1: Incision - An incision is made in the common bile duct to access the biliary system. This allows the surgeon to directly visualize and address any obstructions caused by stones.
• Step 2: Exploration and Removal of Stones - The surgeon explores the main and segmental intrahepatic ducts, using tools such as forceps, scoops, or irrigation to remove any calculi found within these ducts. This step is crucial for restoring normal bile flow.
• Step 3: Cholecystotomy (if needed) - If stones are present in the gallbladder, a cholecystotomy is performed. An incision is made in the gallbladder to decompress it, and any stones are removed. The gallbladder is then inspected to ensure free flow of bile.
• Step 4: Exploration of the Cystic Duct - The cystic duct is explored to identify and remove any obstructing stones, which may be manually milked back into the gallbladder for removal.
• Step 5: Placement of T-tube (if necessary) - In cases where multiple stones are present or continuous drainage is required, a choledochostomy tube (T-tube) is placed. The gallbladder is closed around the T-tube, and drains are placed in the abdomen before closure.
• Step 6: Transduodenal Sphincterotomy or Sphincteroplasty (if performed) - If indicated, the second part of the duodenum is exposed and incised, allowing access to the sphincter of Oddi. The sphincter is identified and divided, extending the division to the dilated portion of the bile duct to facilitate the removal of any stones. Finally, the common bile duct and duodenum are sutured together to complete the procedure.

3. Post-Procedure

After the completion of the choledochotomy or choledochostomy, patients typically require careful monitoring for any complications. Post-procedure care may include managing the T-tube if placed, monitoring for signs of infection, and ensuring proper drainage of bile. Patients may also need to follow specific dietary guidelines and may be advised to avoid certain activities during the recovery period. The expected recovery time can vary based on the patient's overall health and the complexity of the procedure performed.