Principles in operative treatment of residual bile duct stones.

Of sixty-five patients with residual bile duct stones 17 patients had a supraduodental choledochotomy as the only operative procedure. Of the remainder, 48 patients, a supplementary sphincteroplasty was carried out in 36, and a choledochoduodenostomy was added in 12 patients. Early postoperative results showed two deaths, while 40 patients passed an uneventful postoperative course. Following sphincteroplasty three patients had residual stones at the postoperative cholangiography. These calculi had disappeared at follow-up examination. Follow-up examination with a mean observation period of six years revealed 50 patients free of symptoms. Four patients were re-operated on because of residual stones. None of these had a sphincteroplasty. It is concluded that in the operative treatment of residual bile duct stones sphincteroplasty and choledochoduodenostomy offer valuable supplements to the supraduodenal choledochotomy.