A review of the literature indicates that, despite the most careful surgical exploration and operative cholangiography, a significant number of retained or re-formed common duct stones are demonstrated by postoperative x-ray studies, symptomatology, and subsequent surgery. The purpose of this paper is to discuss the reduction of this number by the use of prophylactic transduodenal choledochoduodenostomy (sphincteroplasty) (TCD). The term residual stones will include both retained and re-formed stones.
The Incidence of Residual Stones
Best8 has stated that no matter how carefully a duct is explored, stones will be missed in some cases. A representative group of reports on residual stones is presented in Table 1.More exhaustive surveys of the literature by Glenn,23 Johnston,32 and Smith55 reported a range in incidence from 2% to 28%. In Johnston's series, there was an additional number of clinically suspected but not proved residual stones. In Colcock's personal series