This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citing articles on HighWire  • Citing articles on Web of Science (47)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Francesco Cetta, MD

Arch Surg. 1993;128(3):329-336.

Abstract
• 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)

Author Affiliations
From the Interuniversity Center for Research in Hepatobiliary Diseases, Institute of Surgical Clinics, University of Siena, (Italy).

Footnotes
Accepted for publication August 15, 1992.

Reprint requests to Istituto di Clinica Chirurgica, Nuovo Policlinico, Siena, Italy 53100 (Dr Cetta).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Technical Considerations and Laparoscopic Bile Duct Exploration: Transcystic and Choledochotomy
Lezoche and Paganini
SURG INNOV 2000;7:262-278.
ABSTRACT  

Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy
Lai et al.
Gut 1997;41:399-403.
ABSTRACT | FULL TEXT