Secondary exploration of the biliary tract

Abstract

The charts were examined of sixty-nine patients who between January 1, 1958 and July 1, 1964 underwent a secondary operation on the biliary tract. The median period of relief after cholecystectomy was two years for patients who later proved to have stones in the common duct, and five years for those found to have other disease of the biliary tract. Only twenty patients had the triad of pain, jaundice, and fever whereas twenty-three patients were never jaundiced. Although a normal intravenous cholangiogram did not always exclude disease of the bile ducts, the examination was of aid in selecting patients for reoperation. Operative findings consisted of stones in the common bile duct in twenty-nine patients, a cystic duct or gallbladder remnant in fourteen, stricture of the common duct in five, stenosis of the papilla of Vater in five, pancreatitis in eight, cancer of the biliary tract in four, and negative exploration of the duct in four patients. Various means of evaluating the condition of the biliary tract are discussed. Transduodenal exploration of the papilla of Vater and sphincterotomy may be employed to aid in and verify the removal of stones impacted in the terminal duct and to relieve stenosis of the sphincter of Oddi. Although no single method of inspecting the bile ducts is infallible, it would seem that their combined application would reduce the frequency of secondary operations on the biliary tract.