Extent of choledochoscopic utilization in common bile duct exploration.

Various reports have demonstrated that the intraoperative utilization of the choledochoscope has significantly reduced the incidence of unsuspected retained common duct stones from approximately 10 percent to 0 to 2 percent. Our series revealed a 4 percent incidence of retained stones before choledochoscopy was utilized. This incidence was reduced to 1.1 percent after it was employed. Since the availability of the choledochoscope is unknown, all hospitals in Alabama with 60 or more beds (total of 86) were surveyed to determine the rate of choledochoscopic utilization. Although this instrument was noted to be readily available in many of those institutions with greater than 150 beds (47 percent), only 25 (29 percent) of all the hospitals surveyed had the choledochoscope. Furthermore, only 17 (20 percent) of all hospitals used the instrument routinely for common duct exploration. Although the rate of retained common bile duct stones in Alabama is unknown, it is probably similar to the 10 percent average reported. Consequently, it is believed that wider acceptance of the choledochoscope will reduce the incidence and associated morbidity of retained common bile duct stones.