EFFECT OF OPERATIVE CHOLEDOCHOSCOPY AFTER CHOLEDOCHOLITHOTOMY ON THE INCIDENCE OF RETAINED STONES

Objective: To see whether the introduction of operative choledochoscop y would lower the incidence of retained stones in the common bile duct . Design: Retrospective study. Setting: Mora Hospital, Mora, Sweden. S ubjects: 176 patients who underwent exploration of the common bile duc t from 1984-1991. Interventions: After exploration of the common bile duct, 109 of the 176 patients underwent choledochoscopy; the remaining 67 had the choledochotomy closed over the T-tube, and an operative ch olangiogram done. Results: Six of the 109 patients (6%) who have had c ommon bile duct exploration followed by choledochoscopy were found to have residual stones and in 1 of those 6 no stones had been found on t he exploration of the duct. Ten of the 67 patients (15%) who had chole docholithotomy followed by an operative cholangiogram had residual sto nes, and in two of those no stones had been found on exploration. The annual frequency of choledochoscopy after exploration of the common bi le duct increased from 50% to 80% over the period. Conclusion: We reco mmend that operative choledochoscopy should always be done after explo ration of the common bile duct to reduce the incidence of retained sto nes.