Choledochoscopy in management of retained biliary stones and recurrent lesions

Postoperative choledochofiberscopy was performed in 188 patients with retained biliary stones and recurrent lesions. The following entrances to the biliary tract for choledochoscopy were used: the T-tube tract (129 patients), an afferent jejunal limb of a choledochojejunostomy (43), the jejunostomy tube tract of an efferent limb (12), an U-tube tract (2), and a ductal fistula after segmental liver resection (2). 380 choledochoscopic sessions were carried out, 2 sessions on the average for each patient. The overall success rate of stone removal was 90.5%. No mortality was related to this procedure. Eleven patients developed fever and chills after manipulations but all responded to antibiotics. Two patients had perforation of the T-tube tract during the removal of stones and were reoperated on for abdominal drainage. They recovered eventually. Stone extraction with a flexible choledochoscope is a proven procedure. For residual intrahepatic stones, however, a satisfactory entrance into the biliary tree should be provided for subsequent stone removals. We believe that the jejunostomy tube tract of an efferent limb of an afferent jejunal limb of a choledochojejunostomy is a useful entrance for choledochoscopy because it is permanent in meeting therapeutic demands.