Recurrent common bile duct stones associated with periampullary duodenal diverticula and calcium bilirubinate stones.

We reviewed operative procedures, type of stones, and coexistence of periampullary duodenal diverticula in 115 patients with common bile duct stones who underwent first surgery at our department between 1982 and 1991. Among these patients, 109 underwent choledochotomy with T-tube drainage, 4 underwent side-to-side choledocho-jejunostomy, and 2 had end-to-side choledochojejunostomy. Five patients developed recurrent common bile duct stones (RCS) after surgery. All these patients were older women who had calcium bilirubinate stones in the common duct and coexisting periampullary duodenal diverticula. No patients who underwent end-to-side choledochojejunostomy developed RCS after the initial surgery or reoperation. The results of the present study suggest that both calcium bilirubinate stones and periampullary duodenal diverticula are contributing factors in the development of RCS in patients with common bile duct stones, and that end-to-side choledocho-jejunostomy should be considered for patients with these two factors after the initial common duct exploration.