Abnormal drainage of the biliary tree after relief of long-standing extrahepatic biliary obstruction

To assess the progress of pathologic changes of the biliary tree and particularly their role on biliary drainage after the relief of long-standing extrahepatic biliary obstruction, 100 patients with postcholecystectomy choledocholithiasis who underwent choledochoduodenostomy as a supplementary procedure to choledochotomy were assessed by use of barium meal follow-through studies at different postoperative intervals. Patients were divided into two groups (50 patients each). Group A included patients over 50 years of age with a history of symptoms for more than 10 years. The additional criterion used for these patients was the finding of a common bile duct dilatation greater than 3 cm. In contrast, Group B included patients under the age of 50 years with a comparatively shorter history of symptoms (that is, less than 10 years) and with a common bile duct dilatation less than 3 cm. Results revealed that a major proportion of patients in the first group had no effective decompression of their ductal systems and that there existed a feature of biliary stasis associated with a higher incidence of both bile infection and pathologic changes of the biliary tree.