Sphincterotomy treatment for biliary tract stones. A retrospective review

A series of 106 patients with biliary tract stones is reported. The patients underwent supraduodenal choledochotomy, with an attempt to carry out conventional sanitation of the biliary tract, before a transduodenal sphincterotomy was done. Indication for sphincterotomy was mainly presence of wedged papillary stones or multiple common duct stones. Of the entire series, 52 attended for follow-up study after a period of at least 2 years postoperatively, and underwent intravenous cholangiography, 51 patients had papillary stones removed via the sphincterotomy. Stones were missed in 8 of 102 patients, but were passed spontaneously in 2 patients during the observation period. Postoperative mortality was high (10%)--4 patients developed a fatal pancreatitis. It is concluded that the procedure of sphincterotomy allows certain identification and removal of wedged papillary stones, but does not always allow that missed stones will be passed spontaneously. The possible significance of transpapillary drainage in the subsequent development of pancreatitis is considered.