Transduodenal exploration of the common bile duct in a district general hospital

In an 8 year period 214 transduodenal explorations were undertaken in a district general hospital. These were performed on 208 patients and in 40 instances a combined supraduodenal and transduodenal approach was employed. There were 23 deaths in 208 patients, a mortality of 11%. Twelve deaths occurred in 64 patients who underwent negative exploration. Postoperative pancreatitis was the most common cause of death and the occurrence resulted in a 53% mortality. We conclude that the transduodenal operation should only be performed by experienced surgeons with definite proof of common bile duct stone, and when the standard supraduodenal approach is unsatisfactory.