Retained bile duct stones

Residual bile duct stones were found in 69 out of 4078 patients subjected to cholecystectomy. In 5 of these patients the outcome of the residual stones was unknown, but in 64 patients the complete course of events could be followed. In 32 patients the stone(s) were lodged in the intrahepatic ducts; in 15 patients the stones were overlooked owing to incomplete or technically unfeasible post-explorative cholangiographies; in 12 patients the stones were not visualized in good peroperative cholangiograms and in 5 patients the stones were misinterpreted as air bubbles. Spontaneous passage of the retained stones was verified in 24 patients. In 40 patients re-exploration was performed. Organic changes in the bile duct wall, a large (greater than or equal to 10 mm) and solitary stone were factors that precluded spontaneous passage. Re-exploration of residual bile duct stones, especially during the first month after the primary surgery, was found hazardous. If possible re-exploration should not be performed earlier than 4-6 weeks after the primary operation.