Critical analysis of retained and residual common duct stones

Two-hundred and seven consecutive patients with suspected choledocholithiasis were treated at three university-affiliated hospitals. Twenty-one patients had residual common bile duct (CBD) stones documented after previous biliary tract operations and 28 patients had retained stones in the CBD on predischarge postoperative t-tube cholangiograms. Use of operative cholangiography was analyzed to determine correlation with the incidence of retained and residual CBD stones. Operative cystic duct cholangiography was not done in any patient who developed residual stones after simple cholecystectomy. Twenty-five of the 28 patients (86%) with retained stones either left the operating room with an abnormal postexploration cholangiogram or did not have a postexploration cholangiogram. Only three patients (10%) had falsely negative postexploration t-tube cholangiograms. The percentage of abnormal postoperative CBD exploration cholangiograms that showed filling defects as opposed to ampullary obstruction was significantly higher in patients with retained stones versus patients not having retained stones (P less than or equal to 0.0009). The vast majority of cases of retained and residual stones could be attributed to poor surgical judgment regarding either use or interpretation of operative cholangiography.