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[Dissolution of choledochus stones with heparin-saline solution]
Insights
Bile duct stones after cholecystectomy can be treated. Irrigation with heparin solution successfully dissolved stones in two patients, while others required reoperation for residual bile duct stones.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
Background:
- Cholecystectomy is a common surgical procedure.
- Bile duct stones can be a complication following cholecystectomy, necessitating further intervention.
Observation:
- In 336 cholecystectomies, 18% required bile duct revision.
- Six patients (1.8%) had residual bile duct stones detected postoperatively.
- These stones ranged from one to three per patient.
Findings:
- Three patients with residual stones underwent successful reoperation.
- Three patients were treated with heparin solution irrigation.
- Two patients treated with heparin experienced stone dissolution in 13 and 20 days.
- One patient required reoperation due to septic fever and removal of decayed material.
- All patients achieved complication-free recovery.
Implications:
- Non-operative management with heparin irrigation is a viable option for select cases of residual bile duct stones.
- Early detection and management of postoperative bile duct stones improve patient outcomes.
- Minimally invasive techniques can reduce the need for repeat surgical interventions.
Abstract:
In a series of 336 cholecystectomies a revision of the bile ducts was necessary in 60 cases (18%). One to three residual concrements were evident in 6 patients from control cholangiograms made 8-10 days postoperatively (1.8%). Three of these patients were successfully reoperated. The remaining three were treated by irrigation with a herparin solution: the stones of two patients disappeared in 13 and 20 days, respectively. The third patient had to be reoperated due to septic fever on the 13th day, whereby soft, decayed material could be extracted. All patients had a complication-free recovery. Check-ups made six to twelve months later revealed painfree patients and normal cholangiographic values.