CHOLEDOCHOTOMY, INTRAOPERATIVE ENDOSCOPY AND EXTERNAL BILIARY DRAINAGE IN THE TREATMENT OF THE COMMON BILE-DUCT STONES - A 15-YEAR EXPERIENCE

The treatment of common bile duct stones is controversial. The objecti ve of our study was to report the results of choledochotomy, rigid cho ledochoscopy and systematic external biliary drainage in the treatment of stones of the common bile duel. Over a 15-year period, 555 patient s were operated in our department according to a precise surgical prot ocol. 14% of these patients were operated as an emergency and 11.8% we re operated immediately after endoscopic sphincterotomy. One third of patients suffered from cholangitis. The endoscopic investigation of th e common bile duct was positive in 81.5% of patients. The investigatio n was negative in 18.5% and negative choledochotomy was significantly more frequent in patients operated for acute pancreatitis (p < 0.05). External biliary drainage was performed in 95.7% of patients. When nec essary, a bilioenteric anastomosis (3%) or a surgical sphincterotomy ( 1.9%) was also performed. The postoperative mortality rate was 4.8% si gnificantly higher in patients over the age of 70, in patients operate d as an emergency and in patients operated immediately after endoscopi c sphincterotomy (p < 0.05). The morbidity rate was 8.4%. Residual sto nes were diagnosed in 4.4% of the patients. The presence of residual s tones was significantly more frequent in patients with multiple stones of the common bile duct (p < 0.05). Long-term follow-up was available for 89% of patients, 95% of whom were asymptomatic. These results, ba sed on a homogeneous therapeutic protocol, can be used as a reference for the evaluation of other techniques, especially endoscopic and lapa roscopic techniques.