• Muhammad Rizwan Khan
  • Sameera Naureen
  • Dildar Hussain
  • Rizwan Azami


Background: The frequency of residual common bile duct (CBD) stones in patients with previouscholecystectomy ranges from 2-10%, and a minimally invasive approach is generallyrecommended for these patients. This study reviews the experience in the management of residualCBD stones at the Aga Khan University Hospital. Methods: All adult patients diagnosed to haveresidual CBD stones, from 1993 to 2001, were identified and analyzed in terms of the treatmentmodality utilized and its associated complications. The role of endoscopic sphincterotomy wasparticularly analyzed in our set-up. Results: The study population consisted of 66 patients. Themean age was 52 (range:18-84 years) years with a female to male ratio of 51:15. The primarymode of management consisted of endoscopic sphincterotomy in 61 patients (92.5%). The initialclearance rate for these patients was 75%, while the remaining 25% required ancillary proceduresto achieve a complete clearance. Procedure related complications were observed in 17 (28%)patients, with zero mortality. The other 5 patients (7.5%) underwent an open choledochotomy as aprimary procedure with no further complications. Conclusions: Endoscopic sphincterotomy is themost frequent treatment modality used for the management of residual CBD stones at our hospital.Although initial success rate seems low, the fact that endoscopic sphincterotomy is a less invasiveprocedure justifies its preferential utilization. The study does not compare the results ofendoscopic management with open surgery, as the number of patients managed by opencholedochotomy is very small.Keywords: Common bile dust stones, Retained common bile duct stones, Endoscopicsphincterotomy, Endoscopic retrograde cholangiopancreaticography


Pitt AH. Role of Choledochotomy in the Treatment of

Choledocholithiasis. Am J Surg 1993;170:483-6.

Stain SC, Cohen H, Tsuishoysha M, Donovan AJ.

Choledocholithiasis: Endoscopic Sphincterotomy or

Common Bile Duct Exploration. Ann Surg 1991;213:627-34.

Nauhaus H. Prospective Evaluation of the use of endoscopic

retrograde cholangiography prior to laparoscopic

cholecystectomy. Endoscopy 1992;24(9):745-9.

Ludwig K, Bernhardt J, Steffen H, Lorenz D. Contribution of

intraoperative cholangiography to incidence and outcome of

common bile duct injuries during laparoscopic

cholecystectomy. Surg Endosc 2002;16(7):1098-1104.

Flum DR, Koepsell T, Heagerty P, Sinanan M, Dellinger EP.

Common bile duct injury during laparoscopic

cholecystectomy and the use of intraoperative

cholangiography: adverse outcome or preventable error?

Arch Surg 2001;136(11):1287-92.

Thornton DJ, Robertson A, Alexander DJ. Laparoscopic

cholecystectomy without routine intraoperative

cholangiography does not result in significant problems

related to retained stones. Surg Endosc 2002;16(4):592-5.

Neuhaus G. Prospective evaluation of the use of endoscopic

retrograde cholangiography prior to laparoscopic

cholecystectomy. Endoscopy 1992;24:745-9.

Graham SM. Laparoscopic cholecystectomy and common

bile duct stones. Ann Surg 1993;218:61-7.

Braghetto I, Debandi A, Korn O, Bastias J. Long-term follow

up after laparoscopic cholecystectomy without routine

intraoperative cholangiography. Surg Laparosc Endosc


Vezakis A, Davides D, Ammori B, Martin IG, Larvin M,

McMahon MJ. Intraoperative cholangiography during

J Ayub Med Coll Abbottabad 2005;17(3)

laparoscopic cholecystectomy. Surg Endosc


Csendes A. World progress in Surgery: Common bile duct

stones – Introduction. World J Surg 1998;22(11):1113.

Schmitt CM, Baillie J, Cotton PB. ERCP following

laparoscopic cholecystectomy: A safe and effective way to

manage CBD stones and complications. HPB Surgery


Fiore NF, Ledniczky G, Wiebke EA, Broadie TA, Pruitt Al,

Goulet RJ et al. An analysis of perioperative cholangiography

in one thousand laparoscopic cholecystectomies. Surgery


Rosenthal RJ, Rossi RL, Martin RF. Options and strategies

for the management of choledocholithiasis. World J Surg


Jafri SMW. Approach to the difficult common bile duct

stone. Pakistan J Gastroenterol 1995;9(2):11-4.

Phillips EH, Rosenthal RJ, Carroll BJ, Fallas MJ.

Laparoscopic transcystic common bile duct exploration. Surg

Endosc 1994;8:1389-94.

Kapoor R, Pradeep R, Sikora SS, Saxena R, Kapoor VK,

Kaushik SP. Appraisal of surgical and endoscopic

management of choledocholithiasis. Aust N Z J Surg


Johnson AS, Ferrara JJ, Steinberg SM, Gassen GM, Hollier

LH, Flint LM. The role of endoscopic retrograde

cholangiopancreaticography: sphincterotomy versus common

bile duct exploration as a primary technique in the

management of choledocholithiasis. Am Surg 1993;59(2):78-

Suc B, Escat J, Cherqui D, Fourtanier G, Hay JM, Fingerhut

A, et al. Surgery vs endoscopy as primary treatment in

symptomatic patients with suspected common bile duct

stones: a multicenter randomized trial. French Association

for Surgical Research. Arch Surg 1998;133(7):702-8.

Kharrat J, Kchaou-Ouakaa A, Bel-Hadj N, Gargouri D,

Kochlef A, Romani M, et al. Endoscopic treatment of

residual lithiasis. 661 cases. Tunis Med 2005;83(1):13-7.


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