The choledochus revision in the age of endoscopic papillotomy. Indication and results

Objective: In the age of endoscopic papillotomy (EPT) the operative revisio n of the bile duct needs to be used stringently and interventional therapeu tic options have to be considered primarily in the treatment of gallbladder and bile duct stone disease. Patients and methods: 70 patients treated by choledochus revision for chole cysto- and choledocholithiasis in our department between 1988-1999 were ana lyzed retrospectively for indication and results. Results: ERCPs were performed in only 24 patients. In 17 patients no endosc opic papillotomy could be accomplished due to a former operation (Billroth II or Whipple-OP). 70 patients underwent a surgical bile duct exploration w ith insertion of a T-drainage. The postoperative surgical complication rate amounted to 36 %. The most frequent complications after revision of the co mmon bile duct were edematous pancreatitis as well as bile duct fistula. 37 of 70 patients could be reexamined 4-48 months postoperatively. A pancreat itis or stenosis of papilla Vateri were not seen in these patients. In the sonography the common bile duct was inconspicuous. Conclusions: In the therapy of bile duct stones the therapeutic splitting h as become generally accepted. The patients should be submitted to a ERCP wi th EPT and subsequent laparoscopic cholecystectomy. Surgical revision of th e common bile duct nevertheless remains an important tool in the therapy of choledocholithiasis.