Effect of operative choledochoscopy after choledocholithotomy on the incidence of retained stones.

OBJECTIVE: To see whether the introduction of operative choledochoscopy would lower the incidence of retained stones in the common bile duct. DESIGN: Retrospective study. SETTING: Mora Hospital, Mora, Sweden. SUBJECTS: 176 patients who underwent exploration of the common bile duct from 1984-1991. INTERVENTIONS: After exploration of the common bile duct, 109 of the 176 patients underwent choledochoscopy; the remaining 67 had the choledochotomy closed over the T-tube, and an operative cholangiogram done. RESULTS: Six of the 109 patients (6%) who have had common bile duct exploration followed by choledochoscopy were found to have residual stones and in 1 of those 6 no stones had been found on the exploration of the duct. Ten of the 67 patients (15%) who had choledocholithotomy followed by an operative cholangiogram had residual stones, and in two of those no stones had been found on exploration. The annual frequency of choledochoscopy after exploration of the common bile duct increased from 50% to 80% over the period. CONCLUSION: We recommend that operative choledochoscopy should always be done after exploration of the common bile duct to reduce the incidence of retained stones.