REMAINING COMMON DUCT STONES AND THE RECURRENT BILIARY TRACT SYNDROME

CHOLECYSTECTOMY for chronic cholecystitis and cholelithiasis carries a mortality of 2% or less, in competent hands. Recently we reviewed a series of over 300 cholecystectomies in one of our hospitals without a surgical death where the disease and surgery were limited to the gall bladder. When choledochostomy becomes necessary, there is a step-up in the mortality rate. This is probably not due to the technical phase of the added procedure but to the complicated condition having affected other organs, particularly the liver and adjacent structures. We have never seen a stricture develop in a common duct from the mere incising of the common duct to place a T-tube, provided the T-tube was allowed to remain in place at least 10 days.

Stones escaping from the gall bladder and reaching the common duct markedly complicate the condition and affect the mortality rate. All gall-bladder stones are a hazard, but this does