Reoperation for retained and recurrent bile duct stones

The results obtained in 45 patients who underwent 48 common bile duct reoperations for retained or recurrent choledocholithiasis are reported. The preoperative diagnosis was based on intravenous cholangiography and, in jaundiced patients, on echography and percutaneous transhepatic cholangiography with a Chiba needle. The operations performed on the biliary tract were choledocholithotomy and sphincterotomy (46%), choledocholithotomy (21%), sphincterotomy (16%), choledochoduodenostomy (15%) and Roux-Y choledochojejunostomy (2%). There were three (6.6%) operative deaths: one biliary fistula and two massive digestive hemorrhages. Follow-up lasting from six months to 16 years was carried out in 83% of the patients: 73% reported complete well-being. The causes of "secondary" calculosis are analysed with a critical review of the cholangiographic data and the technique performed. The authors conclude that routine operative cholangiography with the possible addition of choledochoscopy, and adequate biliary drainage are sufficient to prevent "secondary" choledocholithiasis.