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KMID : 0378019880310010054
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New Medical Journal
1988 Volume.31 No. 1 p.54 ~ p.58
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Clinical Review of Intra- and Post-operative Choledochoscopy in Retained Stone
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Abstract
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Unsuspected retained calculi are a disturbing postoperative complication for both the patient and he surgeon. Residual bile duct calculi come from 3 sources, namely, retained stones that were overloo.ed during the initial operation, retained stones that were recognized that could not be removed at the ini ial operation, and recurrent stones that form in the bile ducts in association with highly lithogenic bil. .
The management of retained calculi was chiefly dependent upon reoperation in the past. Recently he reoperation can be, reduced by using endoscopic methods such as endoscopic papillotomy .nd choledochoscopic removal of retained calculi, but each procedure has its limitation.
10 intraoperatiye choledochoscopy and 30 postoperative choledochoscopy (iincluding 7 cases w ich were incompletely removed by the intraoperative choledochoscopy) were carried out at the department of surgery, college of medicine, Korea University, from January, 1986 to June. 1987
The results were as follows:
1. Among 10 cases with the intraoperative choledochoscopy, 2 cases with cbD gallstones were completely removed, but only one case of 8 cases with intrahepatic retained calculi was completely removed. 2. The incidence of retained calculi was 14% in the gallstones operations.
3. The sex ratio between male and female was 1:1.7 and the peak age incidence was 12 cases (40% in
the 4th decade.
4. The choledochoscopy was carried out from one time to sixteen times in according to the case. Cal uli within CBD were completely removed by one time choledochoscopy. But the average choldedochoscorpy was 3.5 times and successful in 72% of intrahepatic retained calculi.
5. The complication, acute cholangitis, was occurred in 3%.
As a result the intraoperative choledochoscopy was useful to remove calculi within CBD and to .onfirm locations of the gallstones, but unsuccessful to remove intrahepatic calculi which were located at the intrahepatic peripheral bile duct. Therefore the intraoperative choledochoscopy was less useful than postoperative choledochoscopy in removing stones in the intrahepatic duct. I think it was attribute, to 3 causes; First, the visual field was disturbed by cholangitis such as purulent exudate, mucosal congestion and edema. Second, the bile duct lumen was not enclosed because of opening the bile duct. Third, because bile duct was weak due to loss of elasticity and was intussuscepted by extraction of impacted stones under the general anesthesia, it was difficult to remove intrahepatic calculi during the operat on. So the postoperative choledochoscopy was more effective than the intraoperative choledochoscopy in re oving retained intrahepatic calculi.
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