Primary common bile duct stones are far more common in Korea than in western coun-tries and are responsible for much of the serious morbidity of gallstone disease. The accurate identification of the primary common bile duct stones by their clinical and morphological characteristics and various diagnostic procedures and their removal by the most adequate surgical procedure to prevent postoperative complications such as cholangitis or retained or recurrent calculi are major objectives of biliary surgery.
In an effort to find out the most appropriate surgical procedure for primary common bile duct stones the author reviewed 93 patients with primary common duct stones who had been operated upon at Department of Surgery, Busan National University Hospital from Jan. 1974 to Dec. 19E3.
The results obtained were summarized as follows:
1) In age distribution the majority of primary common duct stones occurred in age between 40 and 69. Male to female ratio of incidence was 1: 1.5.
2) Main clinical manifestations on admission were right upper quadrant abdominal pain, jaundice, fever and chill.
3) Increased level of serum alkaline phosphatase was the most marked laboratory finding.
4) The majority of patients(59 cases, 63.4%) had single stone in the common. bile duct.
5) The diameter of the common bile duct was between 2 and 3 cm. in the largest number
of patients (44 cases, 47.3%).
6) Ampullary stenosis was found to be present in 47 cases(50.5%).
7) Transduodenal sphincteroplasty was the most commonly performed operative procedure (53 cases, 57.0%) and was the most effective in bile drainage and could be carried out without limitation of common duct diameter. Choledochoduodenostomy and choledochojejuno-stomy were performed in 23 cases (24.7%), 14 cases(15.1%) respectively with favorable results. In 3 patients with poor general health only choledocholithotomy was carried out.
8) Postoperative T-tube cholangiography and Barium meal upper G- I study revealed good
flow of contrast into the intestine and there was no reflux of contrast into the. biliary tree on erect position and no evidence of cholangitis was observed.
9) Postoperative complications developed in 12 cases(12.9%), of which three cases died with operative mortality of 3.2%.
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