Choledochoscopy versus postexploratory cholangiography in prevention of retained common duct stones.

A prospective comparison of flexible choledochoscopy with postexploratory T-tube cholangiography for detecting retained common duct stones was performed in a series of 197 consecutive patients undergoing cholecystectomy and choledocholithotomy. After common duct exploration and apparent removal of stones more missed stones were detected and successfully removed in the choledochoscopy group (n = 15) than in the cholangiography group (n = 7). Retained stones occurred in one of 75 patients (1.3%) after choledochoscopy, in 7 of 79 (8.9%) undergoing T-tube cholangiography only and in 5 of 43 (11.6%) with no postexploratory control. The difference was significantly (p less than 0.05) in favour of choledochoscopy. The operation time was not significantly prolonged and there was no increase in postoperative complications due to choledochoscopy. Choledochoscopy is considered to be the best means of reducing the rate of retained common duct stones and it is recommended after every choledocholithotomy.