Postoperative choledochoscopy through the T-tube tract.

Abstract

The present management of retained biliary calculi utilizing irrigation with heparin and other agents through the T tube has proved disappointing. The use of basket catheters under fluoroscopy is more successful but has limited usefulness in extraction of impacted and certain other stones. The preliminary use of postoperative choledochoscopy utilizing a choledochofiberscope passed through the T-tube tract has been consistently effective in 17 patients for evaluation of filling defects on the postoperative cholangiogram and for the removal of difficult or multiple retained stones. Introduction of the endoscope may require dilation of the T-tube tract. This is accomplished with ease. Use of the recently available T tube with a larger external limb will improve postoperative access to the common bile duct for direct visual examination and removal of stones.