Surgical approaches to primary choledocholithiasis: internal or external drainage when, how and why

Six hundred and twenty two patients underwent choledochotomy because of biliary calculous disease in a series of 4,202 patients seen between 1964 and February 1981. Per-operative and post-exploratory cholangiography was routinely used, and since 1972 choledochoscopy was carried out in addition in a proportion of patients irrespective of intra-operative cholangiographic findings but with clinical and operative findings suggestive of choledocholithiasis. Moreover, choledochotomy was supplemented in 145 patients by T-tube drainage, in 342 patients by choledochoduodenostomy and in 115 patients by sphincteroplasty. Supplementary drainage procedures were carried out in patients with predictive signs of biliary stasis in an attempt to eliminate recurrent choledocholithiasis. From our results it seems reasonable to accept that supplementary drainage procedures in combination with modern intra-operative diagnostic techniques, appeared to be an effective and satisfactory approach in fulfilling the goal of elimination of residual or retained common bile duct calculi.