Choledocholithiasis -a plea for biliary fenestration.

António Mendes de Almeida, Caetano Winston Gracias, Noel Medina dos Santos, Fernando Aldeia

Abstract


A retrospective analysis is made, from the Authors experience with Biliary Tract surgery, for cholesterol lythogenic diathesis and/or its consequences, during a period of time encompassing Jan. 73 - July 1980. Primacy surgery was done en 185 patients while 14 others required 15 reoperations, 7 of which were, primarily, operated upon by the Authors, for a total of 200 interventions. On those undergoing primary surgery there were 132 simple cholecystectomies while on 53 a CBDE was indicated, as well. Among these a simple choledocholythotomy with a temporary decompression via a T-tube was carried out in 14 pts., 5 of which (35%) required resurgery for residual lythiasis in 1, recurrent stones in 3 and a stenotic papilla in the other, whereas 39 pts. undergoing, primarily, a permanent vent remain asymptomatic, without cholangitis. From this experience it is concluded that a biliary «fenestration» procedure should, probably, be carried out whenever there are absolute indications for CBDE, and particularly so when stones are, actually, found inside

of it. Analyzing their series of 42 L-L Choledochoduodenostomies (33 primary cases plus 9 reoperations) it is concluded that this is a safe operation with a very low operative morbidity and mortality rates, a postoperative hospital stay similar to a simple cholecystectomy and without the inconveniences usually and erroneously ascribed to it.


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