Removal of retained stones from the common bile duct - Tips from Other Journals

Date: June, 1992

Although the incidence of retained stones following common bile duct exploration has fallen, 5,000 cases still occur each year in the United States. Because of the high morbidity and mortality associated with reoperation to remove retained stones, interest has focused on new nonsurgical techniques to remove common duct stones. Hieken and Birkett report their experience with a fiberoptic flexible choledochoscope to remove retained stones.

The study included 126 patients with filling defects demonstrated on T-tube cholangiography following cholecystectomy. Of these patients, 21 had normal findings on choledochoscopic examination. Of the remaining 105 patients, 99 (94 percent) had retained calculi successfully removed by choledochoscopy through T-tube. Extraction was not possible in six patients for technical reasons. Choledochoscopy was performed no sooner than 3.5 weeks after the initial gallbladder surgery. Patients received intravenous sedation and prophylactic antibiotics. Minor complications, principally fever and local pain, occurred in 12 patients (9.5 percent), but no serious complications occurred.

The study findings demonstrate that T-tube choledochoscopy is a safe and effective technique for removal of retained stones in the common bile duct. One advantage of this procedure is that it allows direct visualization of the ducts. In addition, radiation exposure is avoided and the procedure can be performed on an outpatient basis. (American Journal of Surgery, January 1992, vol. 163, p. 28.)

COPYRIGHT 1992 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group

 
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