Success of biliary surgery depend upon the incidence of residual gallstone after surgery. Residual
gall stone could be detected by means of T-tube cholangiogram postoperatively. To clarify fate and
management of this problem, the auther made a clinical study on residual stone after gallstone
surgery during five year period from the Dept. of Surgery, Seoul National University Hospital.
Total number of patient are 21, which was selected from 330 gall stone disease patient.
Following result were obtained:
1. Incidence of residual stone on T-tube cholangiogram is 8%.
2. Location of residual stone on 1st cholangiogram were
Rt. hepatic duct 3 cases
Lt. hepatic duct 5 cases
Both hepatic duct 7 cases
Prox. CBD 3 cases
Dist. CBD 3 cases
3. Number of residual stone on 1st cholangiogram are
a. hepatic duct stone below 5 4/15
6∼10 5/15
above 10 6/15
b. CBD stone single 4/6
multiple 2/6
4. Size of stone on 1st cholangiogram:
below 0.5㎝ 18/21
0.6∼1.0㎝ 3/21
5. Follow up cholangiogram revealed minor variation in size, number, and movability, but no
spontaneous passage except 2 cases.
6. Indication for reoperation were
a. no mobilization or decrease in size of residual stone after adequate observation period.
b. clinical symptom on T-tube clamping.
c. in case of complication of long standing T-tube.
7. Of 8 patient who showed residual stone despite second surgery, T-tube were removed in 5
patients without untoward symptoms.
8. It is hard to expect spontaneous passage of stone, even in case of sphincterectomy as well as
choledochoenterostomy. Lithothomy combined with by-pass decompression precedures are best
way for dealing with this problem.
Rt. hepatic duct 3 cases
|