Endoscopic sphincterotomy for retained common bile duct stones in patients with T-tube in situ in the early postoperative period

Abstract

We report on thirty-nine patients who underwent endoscopic sphincterotomy (ES) and stone extraction for retained common bile duct calculi with a T-tube in situ. Sixteen of the patients had undergone unsuccessful attempts at removal by flushing or dissolution by cholesterol solvents. A total of 76 stones were present: 53 distal to the T-tube and 23 proximal to the T-tube. ES and clearance of the common bile duct was achieved in 37 patients (95 per cent) and complications occurred in three patients (7.7 per cent). This method is an effective and relatively safe method in the early postoperative period allowing rapid treatment during the same admission as for the original operation and early hospital discharge.

Do all patients with abnormal intraoperative cholangiogram merit endoscopic retrograde cholangiopancreatography?

“…In the preoperative setting, inability to predict accurately which patients have CBD stones is problematic because when stones are suspected on the basis of clinical, biochemical, and imaging tests, normal preoperative ERCP results still are obtained for 40% to 70% of patients [2,3,5,17,28,40]. The optimal technique for biliary ductal clearance should be based on the local availability of expert endoscopists, surgical expertise in laparoscopic CBD surgery, and the general condition of the patient [9,32,41].…”

Results of the routine use of a modified endoprosthesis to drain the common bile duct after laparoscopic choledochotomy

“…Postoperative cholangiogram through a T-tube is a simpler procedure than ERCP to identify residual stone, and if necessary the T-tube tract can be used to flush out stones with heparinized or saline solution and ceruletide to relax the sphincter of Oddi [7,8,17]. Other alternatives include retrieval through endoscopic sphincterotomy and choledocholithotomy.…”

Laparoscopic common bile duct exploration

“…The surgeon must realize, however, that ERC ± S is not without its own set of complications. Morbidity and mortality rates as high as 5-19% and 1.3%, respectively, have been reported [27,28].…”