We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Do Surgical and Endoscopic Sphincterotomy Prevent or Facilitate Recurrent Common Duct Stone Formation?

Francesco Cetta, MD
Arch Surg. 1993;128(3):329-336. doi:10.1001/archsurg.1993.01420150085016.
Text Size: A A A
Published online


• The possible formation of brown recurrent common duct stones (RCS) as a long-term side effect of sphincterotomy (SPHT) has been evaluated in 63 patients with stone formation after cholecystectomy, 253 who underwent SPHT or choledocholithotomy, 131 with postoperative monitoring of bile bacteriologic characteristics through the T tube, and 20 with stone and bile analysis at both operations. In addition, findings are also reported in 145 patients who underwent surgical SPHT and radiologic review of up to 28 years after surgery, five who underwent ampullectomy, and 55 who underwent endoscopic SPHT. The RCS were usually brown (72.5% of cases), and were always associated with bile infection caused by Escherichia coli. Sixty-two percent of brown RCS were found after SPHT. Eleven percent of patients who underwent surgical SPHT, 9% who underwent endoscopic SPHT, and 66.6% who underwent ampullectomies had brown RCS. Sphincterotomy determined a fivefold greater incidence of postoperative bactibilia, and a sevenfold greater incidence of brown RCS, than did choledocholithotomy. It is suggested that (1) since brown RCS are secondary to bile contamination from the duodenum, SPHT (and subsequent stricture), facilitating both bile contamination and bacterial overgrowth, could be considered a basic factor in the formation of these stones; and (2) since true RCS are mostly of the brown subtype, SPHT could prevent the occurrence of retained stones by flushing the stones that were missed during the first operation, but undoubtedly increases the total incidence of RCS.

(Arch Surg. 1993;128:329-336)


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.