Article

Percutaneous retrieval of retained common bile duct stones

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Abstract

Retained bile duct stones are still a problem in approximately 5% of postcholecystectomy patients.1 Routine operative cholangiograms have not eliminated this problem completely, due to poor technical quality or inaccurate interpretation. Because of the morbidity and mortality of reoperation, development of low-risk procedures was encouraged for the removal of retained stones. This has been recognized since 1891, when Walker2 first instilled ether into the common bile duct to dissolve stones. Since that time, other agents (chloroform,3 heparin,4 cholecystokinin,5 sodium cholate6) have been used in various methods with only partial success. Mondet7 extracted stones through a fibrous tract as early as 1962 with a specially designed forceps. However, with the availability of a steerable catheter (Medi-Tech, Inc., Watertown, Massachusetts) and a Dormia type ureteral stone basket via the T-tube tract, the nonoperative removal of retained stones has become the procedure of choice. Small and moderate sized calculi up to 1 cm can be removed easily; larger stones are usually crushed and then removed. The procedure described here has been utilized on 35 patients at the Cleveland Clinic for the past 3 years with a very low incidence of complication or failures. The purpose of this paper is to discuss our experience with percutaneous retrieval of retained common duct stones with modifications to handle variations in size and location.

Subjects

Between November 1972 and July 1976, 35 patients were referred to the Department of Radiology for evaluation of retained hepatic or common bile duct stones. Of these patients, at T-tube cholangiography . .


 

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