Role of intraoperative flexible Choledochoscopy in calculous biliary tract disease

Ninety six percent of patients with overlooked bile duct stones required surgery within 5 years of cholecystectomy, every effort should be made to keep the incidence of retained stones minimum. The facilities of pre-operative ERCP are not always available. Examination of the bile ducts under direct vision with a choledochoscope seems a certain method of ensuring that there are no residual stone. A total of 26 patients were evaluated between the periods of 2004 to 2005. Age of the patients ranged from 20 to 70 years. The mean age is about 45.88 years approximately. Six (23.07%) cases had previous history of cholecystectomy. Peroperatively 14(53.84%) cases had only choledocholithiasis, 6(23.07%) cases had cholelithiasis with choledocholithiasis, 4(15.38%) cases had choledocholithiasis with hepatolithiasis and 2(7.69%) cases had Mirrizi's type II with choledocholithiasis. After Choledochoscopy, 22(84.61%) cases had complete blind clearance, 4(15.38%) cases had incomplete blind clearance. Twenty two (84.61%) cases did not require any Choledochoscopy guided stone extraction. Four (15.38%) cases required Choledochoscopy guided Dormia basket extraction. Twenty two (84.61%) cases have undergone T tube drainage, 4(15.38%) cases undergone Roux-en-Y hepaticojejunostomy who had associated hepatolithiasis. In this series percentage of stone overlooked by instrumental exploration was 15.38 & percentage of residual stone in this study was 0%.