Combined supraduodenal and transduodenal exploration of the common bile duct with sphincterotomy.

From a consecutive series of 2,221 cholecystectomies, 177 patients underwent combined supraduodenal and transduodenal exploration of the common bile duct and 390 were treated by supraduodenal exploration alone. The mortality rate after both exploration procedures was the same (2.8 per cent). However, two patients died of septic complications associated with duodenal fistulas in the combined exploration group. Five patients had retained stones in the common bile duct which subsequently flushed out with a saline solution irrigation administered through the T tube in three patients and the stone passed spontaneously in one patient. Clinically significant and biochemically documented acute pancreatitis occurred in five patients, one of whom died. Four patients had postoperative cholangitis develop which responded to antibiotic therapy. We are not aware of any patient who had common bile duct stones, chronic pancreatitis or ampullary stenosis after the combined procedure at follow-up study of between six months and 13 years.