Problems of retained calculi in the bile duct.

A study of 68 patients subjected to re-surgery for residual or recurrent gallstones provided the following results: Among the 68 patients, the stones were recurrent in only 4, residual in 38, and uncertain but mostly suggesting residual in the other 26 cases. In many of the residual stone cases, the previous operations were cholecystectomy alone, retrospectively suggesting insufficient search for residual stones and other abnormalities in the biliary tract during the operations. Of the 4 recurrent stone cases, 3 of them showed bile duct stricture, papillary stenosis and idiopathic choledochus dilatation, respectively, while the remaining one, though free of any sign of bile stasis, had a gallstone formed around a silk-thread core. The indications for additional sphincteroplasty and biliodigestive anastomosis in re-operations were strictly consistent with those in the first operations. Seven operative fatal cases (10%) were mostly those of long persistent gallstones with serious hepatic failure. The follow-up studies in 53 patients showed as many as 51 cases returning to the preoperative occupation without any significant complaints. These results emphatically suggest that retained gallstone cases should be referred to surgical treatment as early as possible.