[Changes in the surgical approach of impacted lithiasis in the terminal choledochus]

Transduodenal sphincterotomy used to be was a common procedure when the surgeon couldn't remove stones from the terminal choledochus. We treated 6 patients in whom instead of a sphincterotomy, the stone was left in place and the duct drained with a T-tube. The first three cases were so managed because an emergency left no other option in the other three the decision was elective. Operative cholangiographies showed the impacted stones and in the postoperative cholangiographies, the stones had passed down to the stones had moved upward because of the decompression with the T-tube. The problem in all five patients with residual stone was easily solved. In one patient the stone was moshed down to the duodenum with biliary irrigation. The other four underwent transfistular extraction. Reviewing the morbility of transduodenal sphincterotomy we concluded that in an impacted stone it has currently few indications. In this era of "Biliary Perestroika" and specifically in emergencies or surgeons not fully experienced in transduodenal sphincterotomies, to put a T-tube and in the postoperative period complete others non surgical methods is an acceptable criteria. Also this approach can be applied to laparoscopic surgery when the operative cholangiography shows an unexpected biliary duct stone. The technique of leaving a transcistic catheter followed in the postoperative period by other therapeutic methods maintained in the discussion, could avoid a conversion to laparatomy or a laparoscopic choledochotomy, technique still in a developing period.