Nonoperative extraction of retained common duct stones.

Nonoperative extraction of retained common duct stones was successful in 17 patients during the past two years. Eleven required only one manipulation; the largest number of manipulations required was five. The Burhenne catheter and Dormia basket were employed frequently, but were not always effective. When difficulties occurred with their use, Mazzariello biliary forceps resulted in successful stone extraction, particularly in the management of impacted stones. Extraction procedures were performed under fluoroscopic control, usually on an outpatient basis. Recently, we have employed a flexible fiberoptic endoscope that allows visual investigation of suspected defects and decreases fluoroscopic exposure. These results indicate that all patients with retained common duct stones are candidates for sinus tract manipulation six weeks after common duct exploration. It is recommended that secondary operations for retained common duct calculi not be performed until nonoperative extraction has been given an appropriate trial.