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100 consecutive common duct explorations without mortality.

T N Pappas1, T B Slimane, D C Brooks

  • 1Duke University Medical Center, Department of Surgery, Durham, NC 27710.

Annals of Surgery
|March 1, 1990
PubMed
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Common duct exploration during cholecystectomy is safe, with no deaths and manageable morbidity. Retained stones were successfully treated non-surgically, supporting exploration

Area of Science:

  • Gastroenterology
  • Surgical Procedures
  • Biliary Tract Surgery

Background:

  • Common duct exploration (CDE) is debated for patients with gallbladder in situ due to morbidity and mortality concerns.
  • Endoscopic sphincterotomy (ES) is proposed as an alternative for common bile duct stone removal before cholecystectomy.

Purpose of the Study:

  • To evaluate the current incidence of retained common duct stones after CDE.
  • To determine the morbidity and mortality rates associated with CDE.

Main Methods:

  • Retrospective chart review of 100 consecutive patients undergoing cholecystectomy and CDE (January 1982 - December 1986).
  • Indications for CDE included jaundice, dilated common bile duct, gallstone pancreatitis, multiple small stones, and abnormal cholangiogram.
  • CDE performed via manual technique or choledochoscopy; duodenotomy used in only two cases.

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Main Results:

  • No deaths occurred in the series.
  • Overall morbidity rate was 15.7%, including a 5.3% incidence of retained common duct stones.
  • Major complication rate was 7.4% (DVT, bleeding ulcer, pneumonia); no complications attributed to choledochotomy.
  • All retained stones were removed non-surgically (ERCP or basket extraction), avoiding reoperation.

Conclusions:

  • Operative CDE, when not requiring duodenotomy, is safe and does not significantly increase complications post-cholecystectomy.
  • ES remains a preferred alternative for retained common duct stones.