1976 Volume 18 Issue 3 Pages 428-433
Even with precautions such as operative cholangiography or meticulous technics in exploring the common bile duct, retained biliary stones were still occasionary found within the tract after surgery. On the bassis of experiences of 274 operative and post-operative choledochoscopies in 86 cases including 23 cases with retained biliary stones and 9 cases with intrahepatic stones, retrospective studies on the findings of operative and T-tube cholangiographies performed in 120 cases were carried out to prevent retained stones.In conclusions;1) To overcome the pitfalls of conventional cholangiography, observation and selective cholangiography in conjunction with choledochoscopy seem the most reasonable approarch as a diagnostic test, because cholangiography alone is always inconclusive. And the results obtained in this series indicate that two procedures of choledochoscopy and cholangiography complement one another in avoiding the retained stones.2) Common duct exploration and endoscopic examination should be indicated when the diameter of the common bile duct is more than 1.1 cm to prevent retained biliary stones.3) Difficulties sometimes encountered is that a tortous and a narrow T-tube fistula can not negotiated by choledochof iberscope. To overcome this problem, T-tube which has an adequate diameter should be inserted into the common bile duct at right angles, without a tortous tract in the peritoneal cavity to accomplish observation of whole biliary trees.4) Operative and post-operative choledochoscopies are safe and simple procedures and its routine use is advocated whenever duct exploration is performed.
