Complications analysis with postoperative choledochoscopy for residual bile duct stones

This study was designed to review the experience of this department with the treatment of post-common bile duct exploration residual stones using choledochoscopy and to analyze the complications of choledochoscopy and explore effective methods of prevention.

A choledochoscope (PENTAX fibercholedochoscope and electronic choledochoscope PENTAX ECN-1530) was used. A total of 2,882 postoperative percutaneous choledochoscopy (POC) sessions were performed on 986 patients with residual bile duct stones from 1980 to 2008 (408 men, 578 women; ages range, 21-82 years). Forty-five of these had undergone laparoscopic common bile duct exploration (LCBDE); the rest had open bile duct exploration. Seventy-six participants had choledochoscopy examination (for diagnosis only), and in 910 patients it was performed for both diagnosis and therapy (calculi extraction). In 68 cases, plasma shock wave lithotripsy (PSWL) was performed for larger stones before choledochoscopy extraction.

The mean duration of choledochoscopy was 25 min (range, 10 min to 2 h), with a mean frequency of 2.85 times (range, 1-11). No mortalities occurred. The procedure was unsuccessful in 28 cases in which stones were not accessible because they were embedded in distal hepatic ducts or because they were in proximal ducts that were severely stenosed. Complications resulted in 13 cases and included perforated sinus, biliary peritonitis, sinus hypoplasia, destruction of the T-tube system leading to obstruction, basket incarceration, bleeding, and intestinal fistular. Choledochoscopic stone clearance was achieved in 95.5% of the cases.

Choledochoscopy is an important treatment option for hepatolithus. It has a high efficiency for stone extraction and fewer complications. However, it should be noted that some of its complications are potentially life-threatening.