CHOLEDOCHODUODENOSTOMY AND SPHINCTEROTOMY IN THE TREATMENT OF CHOLEDOCHOLITHIASIS

Over a 10-year period, 2610 patients underwent operation for biliary l ithiasis. Exploratory choledochotomy was indicated in 591 patients (22 .6 per cent). This was followed by simple choledochorrhaphy over a T t ube in 240 patients (40.6 per cent), transduodenal sphincterotomy and choledochorrhaphy over a T tube in 126 (21.3 per cent), supraduodenal choledochoduodenostomy in 216 (36.5 per cent), and choledochoduodenost omy and transduodenal sphincterotomy in nine (1.5 per cent). Choledoch oduodenostomy was performed if the bile duct was more than 12 mm in di ameter. The indication for transduodenal sphincterotomy was the presen ce of a stone impacted in the papilla and/or papillary stenosis. Six p atients developed abdominal abscess and three an external biliary fist ula following choledochoduodenostomy. There were four abscesses and tw o episodes of acute pancreatitis in patients undergoing sphincterotomy . There was no difference in mortality rate between the two groups. Af ter a mean follow-up of 5.6 years, 71.5 per cent of patients who under went choledochoduodenostomy and 75.2 per cent of those who received tr ansduodenal sphincterotomy were asymptomatic. The remainder suffered f rom dyspepsia, colicky pain or episodes of cholangitis. Nine patients underwent reoperation for residual calculi (six choledochoduodenostomi es, three sphincterotomies).