[Bile duct revision, yes or no? Reliability of selection criteria for choledochotomy, tested on the basis of late results following gallbladder operations].

A series of 346 patients with cholelithiasis were followed up 6, 12, 24, and 48 months after the operation and the results were determined by self-assessment and objective criteria (Visick grading) The results were good in over 80% of the patients. The more serious, painful and threatening the situation was before the operation, the better seem to be the later results. The frequency of the postoperative complications and the number of choledochotomies is dependent on the age of the patient. The type of operation and sex has no effect on the duration of postoperative unemployment. On the average the younger patients return to work more rapidly. From the preoperative criteria which may lead to revision of the choledochus the frequency of pain, duration of history and attacks of fever in the history were unreliable, whereas increased age of patient, icterus or pancreatitis in the previous history were increasingly associated with pathology of the choledochus. Intraoperatively numerous small stones, enlarged choledochus and poor flow ( debit ) suggested strongly a stone in the choledochus or stenosis of the papilla. The stones which were palpable intraoperatively were always found, whereas almost one third of the stones in the bile ducts were not palpable. The intraoperative X-ray picture is an useful but not an absolute reliable auxiliary help. Several of the pre- and intraoperative criteria and tests used for the selection of patients for choledochotomy have statistically significant reliable results for the presence of choledocholithiasis or papillary stenosis. Singularly however, there is always the possibility of a false positive or false negative result.