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Jesse E. Thompson, Jr, MD; Robert S. Bennion, MD

Arch Surg. 1989;124(10):1216-1220.

Abstract
• Thirty-two consecutive patients with impacted ampullary or distal common bile duct stones were managed prospectively. Preoperative indications for surgery were obstructive jaundice in 13 patients (40.6%), acute cholangitis in 7 patients (21.9%), biliary pancreatitis in 6 patients (18.8%), acute cholecystitis in 5 patients (15.6%), and chronic cholecystitis in 1 patient (3.1%). No patient had a prior cholecystectomy, and all stones were removed retrograde during cholecystectomy and open-duct exploration. There were no deaths, one retained stone in the biliary radicals, two episodes of mild pancreatitis, one superficial wound infection, and one minor bile leak. All patients have done well on follow-up. This study demonstrated that impacted biliary stones can be consistently and successfully extracted by the supraduodenal approach with minimal morbidity and no mortality, without resorting to duodenotomy and sphincter ablation.

(Arch Surg. 1989;124:1216-1220)

Author Affiliations
From the Departments of Surgery, Olive View Medical Center, Sylmar, Calif, and UCLA School of Medicine.

Footnotes
Accepted for publication June 10, 1989.

Read before the 60th Annual Meeting of the Pacific Coast Surgical Association, Vancouver, Canada, February 22, 1989.

Reprint requests to the Department of Surgery, 2B156, Olive View Medical Center, 14445 Olive View Dr, Sylmar, CA 91342 (Dr Thompson).

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