Retained and recurrent bile duct stones. Surgical or nonsurgical removal?

An experience with 69 patients who underwent 72 common bile duct reoperations for retained or recurrent choledocholithiasis is presented. The mean age of the patients was 57 years, and 35 patients had associated conditions. In this series six patients (8.3%) had minor complications and no patient developed major complications or died. Two (2.9%) patients developed recurrent choledocholithiasis. In recent years, nonoperative removal of retained stones through a T-tube by mechanical extraction or chemical dissolution, and removal of retained or recurrent stones by endoscopic sphincterotomy has gained widespread popularity. Retained or recurrent choledocholithiasis should be managed on an individual basis. Reoperation has a good success rate, low morbidity and mortality rates. It should be considered as the treatment of choice in low risk patients, in whom a retained stone cannot be mechanically extracted through a T-tube, and in patients with recurrent choledocholithiasis diagnosed after removal of the T-tube.