Management of retained common bile duct stones in patients with T-tube in situ: role of endoscopic sphincterotomy.

Abstract

Retained common bile duct stones in postcholecystectomy patients who have a T-tube in situ should be treated, preferably, by nonoperative means. Thus, we treated seven such patients with common bile duct perfusion (through T-tube) of methyl tertiary butyl ether, and 10 patients with perfusion of monooctanoin. However, successful dissolution was achieved in only one and three patients, respectively. Hence, endoscopic sphincterotomy (ES) was performed in the patients in whom solvent perfusion had failed, and in other subsequent patients with T-tube in situ. Of 28 patients thus treated, bile duct clearance could be achieved in 27 (96.5%) patients; minor bleeding occurred in only three patients. After sphincterotomy, the stones passed out spontaneously in 20 patients while the T-tube was still in situ, but in two patients, only after the T-tube was removed. Similarly, basketing of the stones could be done in four patients with the T-tube in position, but in one patient whose ductal stones were above the T-tube, the tube had to be removed to make basketing successful. Endoscopic sphincterotomy is an efficient method of treating retained common bile duct stones in patients with T-tube in situ. However, in those patients whose ductal stones are above or astride the T-tube, the T-tube may have to be removed to attain bile duct clearance.