Common bile duct stones and biliary-intestinal anastomoses.

Abstract

Six patients with symptoms referable to residual or recurrent common bile duct calculi following biliary tract operations, including a biliary-intestinal diversion, were studied by endoscopic retrograde cholangiography. Two patients were treated by endoscopic papillotomy and the remainder, by surgical procedures which included choledocholithotomy, transduodenal sphincteroplasty and revision of the biliary-intestinal anastomosis. Analysis of this experience suggests that one cannot assume that choledochoduodenostomy or choledochojejunostomy will always mitigate the consequences of retained or recurrent common duct stones. The segment of common bile duct between the biliary-intestinal anastomosis and the papilla of Vater may serve as a blind pouch or sump in a small number of patients undergoing these procedures. In patients with choledocholithiasis, efforts to remove all stones from the ductal system are the principal consideration; and choledochoduodenostomy should be reserved for specific indications, such as obstruction of the distal part of the bile duct.