Common bile duct exploration is indicated for radiologically confirmed (laparoscopic or open cholecystectomy) or palpable (open cholecystectomy) gallstones in the duct (choledocholithiasis) that are asymptomatic or causing obstructive jaundice, gallstone pancreatitis, or toxic cholangitis; to diagnose and treat obstructive jaundice from a benign or malignant stricture; to diagnose and treat stenosis of the sphincter of Oddi; or to repair an injury caused by operation or trauma. The need for open or laparoscopic common bile duct exploration has decreased significantly in recent years. In general, a preoperative ERCP with sphincterotomy to allow release of, or access to, common bile duct stones is cost effective if the risk of such stones is 80% or higher. Therefore, patients with resolved cholangitis, persistent jaundice, unresolving pancreatitis, or common bile duct stones documented by other tests are ideal candidates for preoperative ERCP.

General anesthesia is used for both open and laparoscopic common bile duct exploration. The procedure adds 60 minutes to a routine open cholecystectomy because of the need to expose and open the duct (choledochotomy), extract the stones and perform choledochoscopy, insert a T-tube, close the duct around the T-tube, and perform a completion T-tube cholangiogram. Laparoscopic common bile duct exploration also adds 30 to 60 minutes to a routine cholecystectomy. The ideal approach involves balloon dilation of the cystic duct, passage of a flexible fiberoptic endoscope (outer diameter = 3 mm) through the cystic duct, and basket extraction of common duct stones under direct vision.