[Residual choledocholithiasis in elective cholecystectomy and choledocholithotomy]

Cholecystectomy is one of the most frequent abdominal operation. Common bile duct stone may be found in 6-15% of elective cholecystectomics. One or more stones may be left behind within common bile duct. In a series of 106 consecutive cholecystectomics performed in the First surgical clinic in Belgrade over six months period (from 07.08.1997.-31.12.1997.) operative cholangiography was performed routinely in every single case. Unexpected common bile duct stone was found in 13 patients (12.26%). After removal of stones choledochoscopy was performed in 7 out of 13 patients with common bile duct stone (53.8%). An operative T-tube cholangiography was performed in all 13 cases before closure of the abdomen. Postoperatively, usually from 8th to 10th day a secondary T-tube cholangiography in the X-ray department was performed in all 13 cases. Retained stone was found in 2 patients, both in group of patients in whom choledochoscopy had not been carried out. The retained stone was successfully removed endoscopically in one case but the second patient had to be reoperated as endoscopy was unsuccessful. We conclude that choledochoscopy reduces the risk of retained common bile duct stone and it should be practiced whenever possible.