[Common bile duct lithiasis. Reflections apropos of 1000 cases]

One thousand case reports of patients treated in eleven French surgical departments for stones in the common bile duct between 1975 and 1982 were analyzed. One in three cases were asymptomatic and detected by peroperative radiology during treatment of a simple or complicated gallstone, most forms were painful, with jaundice in 9 p. cent, an angiocholitis in 12 p. cent, and biliary pancreatitis in 2 p. cent. The most reliable exploratory procedure for gallstones is ultrasound imaging, as positive results were obtained in 90 p. cent of cases, but it enabled the diagnosis of choledocholithiasis in only one out of five patients. Intravenous cholangiography is a useful diagnostic tod for painful forms (60 p. cent). The failure of these two methods to establish the diagnosis in forms complicated by jaundice, pancreatitis, or angiocholitis has to be compared with the good results (85 p. cent) observed with endoscopic retrograde cholangiography. Treatment was surgical in 99 p. cent of patients, peroperative radiology being performed in 95 p. cent of these cases and endoscopy in 30 p. cent. In one out of two cases a single large stone was present while multiple stones were present in 8 p. cent. A "ideal" choledochotomy was carried out in 77 patients (7,7 p. cent) without mortality. External biliary drainage in 702 cases resulted in a 1.7 p. cent mortality rate, this increasing to 8 p. cent after 192 biliodigestive shunt operations, and 7 p. cent after 146 sphincterotomies, including 18 under endoscopic control. Unrecognized lithiasis, detected during follow-up radiography two weeks after external biliary drainage, accounted for 2-8 p. cent of cases. Of the 30 patients with residual stones and open biliary pathways, 6 were treated by mechanical removal, 6 by endoscopic sphincterotomy, and the others by repeat surgery.(ABSTRACT TRUNCATED AT 250 WORDS)