Results of nonsurgical treatment of retained biliary calculi

During the past six years, 100 patients with retained biliary tract calculi underwent stone extraction, consisting of manipulation of the ductal system through the sinus tract using a variety of flexible catheters, stone baskets and a specially designed forceps and fiberoptic scope. Thirty-one of the patients were referred from outside the Chicago area and 19 of the total group had previously been operated upon at medical school hospitals. Stone extraction was successful in 96 of the total group. Eighty-five of these extractions were accomplished in one to three sessions, while eight of the patients required four to nine sessions before all of the stones were removed. Forty-five patients had multiple stones; 25, single stones; eight, sludge, fragments, mucus or debris, and no stones could be found in 12. Four patients required reoperation following unsuccessful percutaneous duct manipulation. One of these patients died along with two others who had successful extraction procedures. In two additional patients, duct obstruction recurred requiring reoperation three months and one year after manipulation. A high percentage of patients with retained biliary calculi can be successfully treated without reoperation using these methods. Failures are related to poorly placed T tubes, tortuous sinus tracts or dislodged tubes. Major morbidity and mortality are related to biliary obstruction and sepsis. An aggressive approach to infection with urgent nonoperative or operative measures to decompress completely the biliary tree is mandatory to reduce the incidence of major complications in these patients.