[Lithiasis of hepato-cystic-choledochal confluence. Surgical treatment]

The author reviews the case histories of ten patients who had gallstones at the confluence of the cystic and common bile ducts. These were found within a total group of 1,388 patients operated on at the Hospital La Raza between 1971 and 1973 for biliary tract and gallbladder disease. In all of these cases a reconstruction of the common bile duct over a T catheter and extending to the cystic duct was carried out. The usual technique for cholecystectomy could not be used. The satisfactory results were due to the careful dissection of the area, adequate irrigation of the small cystic duct segment used for the reconstruction and to cholangiographic control carried out during surgery. Even though this type of problem in infrequent (0.7%) among biliary tree digestive tract fistulas, we must keep it in mind because it may bring about iatrogenic lesions of the biliary tree which may be fatal. In this small series there were no deaths and the postoperative evolution was satisfactory.