Common-Bile-Duct Stones

Endoscopic Management of Recurrent Primary Bile Duct Stones

“…The aetiology of such stones is unknown. Putative causes include partial or intermittent obstruction of the terminal common duct with cholangitis, 3 the presence of a juxtapapillary diverticulum 4 and biliary stasis.…”

Operative Cholangiography: Evaluation of Its Routine Use in 569 Cholecystectomies1

“…The decision when to explore the common bile duct during surgery for biliary tract disease may be based on many different criteria (Bartlett et alii, 1958;Colcock etalii, 1958;Glenn, 1967;Hilton and Griffin, 1969). The previously established clinical or operative indications are: (i) a past history of jaundice or intermittent jaundice; (ii) the presence of jaundice at the time of surgery; (iii) previous attacks of pancreatitis and the findings of an indurated or thickened pancreas at the time of operation; (iv) the presence of multiple small stones in the gallbladder, particularly with a patent cystic duct; (v) a dilated and thick-walled common bile duct; and (vi) palpable calculi within the bile duct.…”

“…The previously established clinical or operative indications are: (i) a past history of jaundice or intermittent jaundice; (ii) the presence of jaundice at the time of surgery; (iii) previous attacks of pancreatitis and the findings of an indurated or thickened pancreas at the time of operation; (iv) the presence of multiple small stones in the gallbladder, particularly with a patent cystic duct; (v) a dilated and thick-walled common bile duct; and (vi) palpable calculi within the bile duct. Although most surgeons adhere to similar criteria relating to common bile duct exploration, the number of patients undergoing common duct exploration varies considerably among different centres (Bartlett et alii, 1958;Glenn, 1967). The incidence of stones recovered from common duct exploration also varies considerably.…”

“…The incidence of stones recovered from common duct exploration also varies considerably. It is important to avoid unnecessary exploration of the common bile duct, since there is universal agreement that the addition of this procedure to cholecystectomy increases the morbidity and mortality (Glenn, 1967;Jolly et ah, 1968;Glenn et alii, 1968). This is also well reflected in our series, since cholecystectomy alone gave a mortality rate of 0.25%, and the addition of exploration of the common bile duct increased the mortality rate to 6.8%.…”

Operative Cholangiography

“…Clinical or anatomic evidence of pan¬ creatitis 7. Biliary colic without stones in the gallbladder 8. Sediment in the bile aspirated from the common duct 9.…”