The complex pathogenesis of bile duct stones, the anatomical properties of the biliary tree, the patient's age, associated diseases, as well as the technical devices available, may explain the great variety of procedures and preferences of different groups in the treatment of choledocholithiasis. Since no technique is infallible or free of complications, it seems unfair to argue that procedures whose efficacy has been proven by many authors are obsolete. This is the case of choledochoduodenostomy (CDS) in the treatment of common bile duct (CBD) stones. The complications associated with CDS, (ascending cholangitis, and “sump” syndrome) have been overemphasized and have led CDS to be rejected by many surgeons. Our experience with this technique is good and concurs with that of Madden and others.Data on 125 patients with CBD stones treated with CDS between 1968 and 1982 are analyzed. Sixty‐eight of them were female and the mean age was 61.4 years; 73.6% were more than 50 years old. There were frequent accompanying diseases, especially cardiovascular ones. More than half of the patients had a previous operation on the biliary tree. The duct diameter was always greater than 20 mm and it was frequently associated with stenosis of the distal choledochus. Floercken's technique of CDS was the most frequently used, after Kocher's maneuver had been performed. There was no intraoperative mortality. Postoperative mortality was 3.2% and is analyzed in detail. The incidence of postoperative complications was 42.4%. Most were septic complications or those ascribed to accompanying diseases. Late operative cholangitis was present in 1.6% of patients, comparable with reports of other authors. We encourage the use of CDS in the treatment of CBD stones provided that: (a) careful attention is paid to its clinical indications, considering that the patient may benefit from alternative techniques, for example, duodenoscopic papillotomy; and (b) choledochal dilatation is greater than 20 mm in diameter and the choledochal and duodenal walls are normal. We specifically recommend CDS as the primary operation for patients with “choledochal funnel syndrome.” The operation is simple, restores normal digestive function, and almost always resolves the problems of CBD stones in high‐risk patients.

Forty-three patients with invasive adenocarcinoma of the gallbladder were postoperatively studied in order to determine their general immunological status as well as the local immunohistological reaction to the tumor. At the end of the follow-up, they formed two groups: 19 living patients (group GL) and 24 dead patients (group GD). As a control group (GC), 21 patients with cholecystectomy or cholelithiasis and without carcinoma were simultaneously evaluated. In GL, most of the tumors were limited to the gallbladder wall, and in GD, most of the tumors were already disseminated at the time of diagnosis. GD presented a lower percentage of peripheral blood B lymphocytes, as compared to GL and GC cases. Skin tests of delayed hypersensitivity were significantly more reactive in GL cases than in GD cases, and less reactive in GD than in GC cases. The immunohistological evaluation of the gallbladder yielded a lower B lymphocyte infiltration in GD tumors than in the control cases. GL cases showed a higher intratumoral lymphocytic and mononuclear cell infiltration than GD cases. Although the clinical stage was higher in GD than in GL cases, there were also significant differences in the local immune response and the general immunological status. Patients with invasive gallbladder adenocarcinoma showing longer postoperative survival revealed normal or increased local and general immunological reactions, whereas patients with disseminated tumors showed an important humoral and cellular secondary immunodeficiency.