Biliary stone extraction

This report summarizes a 14-year experience with 219 patients referred for sinus tract extraction of retained common duct stones. The patients ranged from 18 to 94 years of age and 60 per cent were women. Forty seven per cent of patients were seen within 6 weeks postoperatively and 79 per cent within 3 months of surgery. Sixty four per cent of patients had a single stone; the remainder had multiple stones, sludge or ductal debris. Sinus tract manipulation under fluoroscopic control was done using a variety of baskets, catheters and instruments, including endoscopy, along with pre- and post-manipulation intravenous antibiotics. Routine testing and cultures are done and useful when clinical biliary sepsis occurs (1%). Meticulous postextraction cholangiography has contributed to our success and is an important part of the procedure, usually done 24 hours after the last manipulation. Successful extraction occurred during a single session in 125 of 219 patients (57%); 60 of 219 patients required two extraction sessions. Four patients spontaneously passed stones. The remaining patients required three to seven sessions before the extraction was considered complete. Successful extraction of all stones and debris from patients' biliary ducts occurred in 210 of 219 cases (96%). Five of the nine failures occurred in the first one hundred patients (1974-1979) and all required reoperation. Failure occurred in four of the last one hundred patients (1979-1986) and all were successfully treated by ERCP extraction. Two deaths occurred very early in our series and were related to advanced biliary sepsis at the time of the initial presentation.(ABSTRACT TRUNCATED AT 250 WORDS)