Experience with routine postoperative choledochoscopy via the T‐tube sinus tract

Abstract

Abstract In the 40‐month period from April, 1974 to July, 1977, postoperative choledochoscopy was performed 566 times in 186 patients at Teikyo University Hospital. Included in this series were 56 patients with retained common bile duct stones and 23 patients with intrahepatic stones; the stones were removed by postoperative choledochoscopy in 52 and 20 of these patients, respectively. In some patients, unsuspected stones were detected endoscopically after a completion T‐tube cholangiogram was reported as negative for stones. Our experience to date indicates that this technique is of substantial diagnostic and therapeutic value in the management of biliary calculi. Therefore, routine use of postoperative choledochoscopy as an adjunct to T‐tube cholangiography is strongly advocated. Failure of attempts to remove retained stones endoscopically and complications in this series were all attributable to inadequate insertion of the T‐tube into the common bile duct at the time of operation. To overcome this problem, a T‐tube of at least No. 18 Fr. caliber, and preferably of No. 20 Fr. caliber, should be inserted at operation into the common bile duct at a right angle, so as to avoid a tortuous sinus tract and produce a tract of sufficient caliber to permit postoperative choledochoscopy.