[Lithiasis of the main bile duct: change in surgical approach]

Should the papilla Vateri be explored during surgery for gallstones of the main biliary tract? A group of 672 choledochotomies were analyzed retrospectively; out of precautions we approached the papilla Vateri in 75% of these cases. This group was compared to a prospective study of 200 consecutive choledochotomies of which 21% required dilatation or sphinectotomy of the papilla Vateri. The number of remaining gallstones was approximately the same in both groups. There were 5 deaths due to postoperative acute pancreatitis in the first series and none in the second. Dilatation of the papilla or sphincterotomy should no longer be performed, routinely in surgery of the biliary tract.