Majority of gallstone disease are curative with initial operation, but small portion of gallstone patients are suffered from residual and recurrent bile duct stone due to overlooked initial opeation and inaccessable surgical procedures.
Because residual and recurrent bile duct stones produce many serious clinical problems, it is necessary for biliary surgeon to have enough caution not to remain the residual stone in bile duct, and make drainage procedure to prevent recurrent
bile
duct
stones.
The author analyzed 96 cases of residual and recurrent bile duct stone which were managed with surgically and interventional radiologically at the Department of Surgery, College of Medicine, Chung-Ang University from Jan. 1984 to Feb. 1992.
@ES The results were as follows:
@EN 1) The ratio of male to female was 1 : 2.4. The peak incidence of age group was the 7th decade.
2) The majority of case was diagnosed by T-tube cholangiogram only (48%) and almost of remainder were diagnosed by ultrasonogram only or ultrasonogram combined with other procedures.
3) The common symptoms and signs were right upper quadrant abdominal pain(63%) and tenderness(39%), fever and chill(21%), jaundice(20%).
4) The abnormal laboratory findings were elevation of SGOT(> 45 IU, 47%), elevation of SGPT(> 45 IU, 35%), in sequence.
5) The sites of residual and recurrent stone were common bile duct with intrahepatic duct(41%), common bile duct only(34%), intrahepatic duct only(24%).
6) A second procedures was performed in 51 cases(53%) within 6 months from previous operation, in 10 cases(10%) between 6 months-2 years, in 35 cases(36%) more than 2 years. The main method of stone removal were Dormia basket in 0~6 months group
and
surgical procedures were performed in more than 6 months groups.
7) The methods of stone removal were Dormia basket(45cases), choledochostomy(39 cases), choledochojejunostomy(12 cases).
8) After second procedures, residual stones were observed in left intrahepatic duct only(15 cases), common bile duct and right hepatic duct in each(6 cases).
9) Stone free rates of second procedure were 52% in choledochostomy procedures, 62% in Dormia basket procedures.
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