Surgical approaches to postcholecystectomy choledocholithiasis.

One hundred sixteen cases if postcholecystectomy choledocholithiasis were assessed after different methods of surgical approach. The evidence that previous surgery, advanced age, and long history of symptoms are associated with a high incidence of bile infection and with advanced histological changes in the biliary ductal apparatus was considered as an index of biliary stasis. It is for these patients that a drainage procedure supplementary to choledochotomy was thought to be warranted. Both choledochoduodenostomy and sphincteroplasty were carried out in this series of patients as drainage procedures supplementary to choledochotomy. Choledochoduodenostomy appears to offer a definitive solution to this problem, and it has been shown to be safe and simple to carry out without mortality and with a very low morbidity.