Common Bile Duct Exploration

  • Jameson L. Chassin


As pointed out by Way, Admirand, and Dunphy, the true incidence of CBD stones in patients undergoing surgery for gallstones is probably between 12% and 15% in the United States. By using indications essentially identical to those stated below and by performing routine preexploratory cystic duct cholangiography, Way performed CBD explorations in only 21% of 952 cholecystectomies. These explorations were positive for calculi in 65% of the patients explored. Of the 952 cholecystectomy cases, 14% had CBD stones. In 6 additional reports collected by Way in which routine cystic duct cholangiography was employed, the results were similar. On the other hand, the same author cited 3 other reports from the Lahey Clinic of cases in which preexploratory cholangiography was not performed. Here, of 33% of patients undergoing CBD exploration only 30% of the ducts contained stones. Whereas the use of routine cystic duct cholangiograms resulted in the recovery of CBD stones in over 14% of the cholecystectomies reported by Way and colleagues, the authors who omitted preexploratory cholangiography were able to discover CBD stones in only 10% of their cholecystectomy cases. In other words, routine preexploratory cholangiography markedly reduces the number of CBD explorations performed yet achieves a higher recovery rate of CBD stones (see Table 50-1).


Bile Duct Cystic Duct Hepatic Duct Bile Duct Stone Residual Stone 
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  1. Allen B, Shapiro H, Way LW (1981) Management of recurrent and residual common duct stones. Am J Surg 142: 41PubMedCrossRefGoogle Scholar
  2. Berci G, Shore JM, Morgenstern L, Hamlin JA (1978) Choledochoscopy and operative flourocholangiography in the prevention of retained bile duct stones. World J Surg 2: 411PubMedCrossRefGoogle Scholar
  3. Burhenne HJ (1976) Complications of nonoperative extraction of retained common duct stones. Am J Surg 131: 260PubMedCrossRefGoogle Scholar
  4. Jones SA (1978) The prevention and treatment of recurrent bile duct stones by transduodenal sphincteroplasty. World J Surg 2: 473PubMedCrossRefGoogle Scholar
  5. Madden JL (1978) Primary common bile duct stones. World J Surg 2: 265CrossRefGoogle Scholar
  6. Nora PF, Berci G, Dorazzio RA, Kirschenbaum G, et al. (1977) Operative choledochoscopy. Am J Surg 44: 105CrossRefGoogle Scholar
  7. Rutledge RH (1976) Sphincteroplasty and choledochoduodenostomy for benign biliary obstructions. Ann Surg 183: 476PubMedCrossRefGoogle Scholar
  8. Saharia PC, Zuidema GD, Cameron JL (1977) Primary common duct stones. Ann Surg 185: 598PubMedCrossRefGoogle Scholar
  9. Thomas CG Jr, Nicholson CP, Owen J (1971) Effectiveness of choledochoduodenostomy and transduodenal sphincteroplasty in the treatment of benign obstruction of the common duct. Ann Surg 173: 845PubMedCrossRefGoogle Scholar
  10. Way LW, Admirand WH, Dunphy JE (1972) Management of choledocholithiasis. Ann Surg 176: 347PubMedCrossRefGoogle Scholar
  11. White TT, Harrison RC (1973) Reoperative gastrointestinal surgery. Little Brown, BostonGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • Jameson L. Chassin
    • 1
    • 2
    • 3
    • 4
    • 5
  1. 1.New York University School of MedicineUSA
  2. 2.Booth Memorial Medical CenterFlushingUSA
  3. 3.University Hospital, New York University Medical CenterUSA
  4. 4.New York Veterans Administration HospitalUSA
  5. 5.Bellevue HospitalUSA

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