Clinical Study of Residual Stone in Choledocholithiasis

Chung, Jung Kee; Suh, Jun Suk; Hong, Inn Gyu; Kwon, Oh Joong; Park, Yeon Ho; Suh, Kyung Suk; Kim, Sun Whe; Park, Yong Hyun

Abstract

BACKGROUND/AIMS: Patient with choledocholithiasis(CL) may have residual stones postoperatively and cholodochoscopic extraction became one of the main therapeutic modalities recently. Analysing the incidence of postoperative residual stones in cholodocholithiasis patients and the effect of choledochoscopic stone remova], we may have the necessity of some modification of operation procedures such as cutaneous jejunostomy.
METHODS
Analysing c]inical data of 64 patients who were confirmed as having biliary stones during operation and were c>perated during the 4 year period until 1994, we investigated the relationship between operation modality and incidence of residual stone and effectiveness of endoscopic extraction and of medical management on postoperative periods.
RESULTS
Residua) stones(RS) were noted in 35.9%(23/64) of operated choledocholithiasis patients and by operative procedure, choledochojejunostomy cases had the highest incidence of RS at 58.3%. Complete removal of RS by choledochoscopy was achieved in 8 of 14 cases and two cases of recurrent and 4 case of remaining stones were managed medically.
CONCLUSIONS
In managing CL patients, left lobectomy of liver is one of tbe definite treatment modalities in left sided CL and in right sided CL with high suspicion of RS, additive cutaneous jejunostomy on conventional choledochojejunostomy may have beneficial ro)e in long term postoperative choledochoscopic trial.