Evaluation of factors affecting the incidence of retained calculi in the bile ducts.
During the 4-year period (1974-1977) 1204 operations were performed for cholelithiasis. Of 139 patients who underwent choledocholithotomy, retained stones in the bile ducts were diagnosed in 22 (15.8%). Peroperative cholangiograms taken before and after exploration of the bile duct were re-examined and compared to a control material. A major factor in the occurrence of retained stones was the number of the stones on the pre-explorative cholangiogram. Among patients with retained stones 64% had five or more stones in their bile ducts on the pre-explorative cholangiogram. The corresponding frequency in controls was only 18% and this difference is statistically significant. Neither the size of stones, nor the diameter of the common duct had any bearing on the incidence of retained stones. On the post-explorative cholangiogram an interrupted passage of contrast medium into the duodenum was no proof of retained stones. False negative cholangiograms after surgical exploration of the common duct were seen in 27% and in the control group there were false positive cholangiograms in 47%. Retained stones that are undiagnosed after operation and those that are known, but cannot be removed, reflect, respectively, diagnostic and therapeutic failure. In this context, measures to improve both these areas are discussed.
D001649:Bile Duct Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D002758:Cholangiography; D002769:Cholelithiasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications