<p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> <p>The occurrence of retained/recurrent calculi after primary CBDE followed by temporary T-tube
decompression, have remained at rates varying from 5.4% to 20.9% over the last 10 years in spite of
sophisticated pre and intraoperative imaging techniques. It is postulated that a functional obstruction,
due to dysmotility of the SO, lies behind most stone-containing ducts. Thus it seems logical to us that a
permanent “fenestration” should be the management of most such ducts.</p> <p>We prospectively followed-up, for one to 10 years, two groups of patients submitted to primary
CBDE aiming to assess the short and long-term results of two different surgical approaches to duct
lithiasis. In one (Group A) 162 CBDE's were performed, out of 680 CHE's (24%), with a “positivity” of 68% and in the other (Group B) 80 CBDE's, out of 438 CHE's (18%), with a “positivity” of 70%. In Group A a T-tube decompression was used in 79(49%) and a definitive drainage in 83(51%) whereas in Group B the T-tube was employed in only 3(4%) and some form of permanent “fenestration” in 77(96%). There were no significant differences between the operative mortality rates, which were 2.5% in Group A (1 death post T-tube, 3 post CDJ) and 1.3% in Group B (1 death post CDD). The long-term results, though, were significantly worse among patients of Group A whose ducts were temporarily
decompressed: 10/79 (12.7%) required further aggressive interventional therapy for retained/recurrent
stones while only 3.8% (3/80) in Group A and 1.3% (1/76) in Group B required revisional surgery for
bilio-digestive anastomotic complications with cholangitis.</p> <p>It is concluded that it is against the long-term efficiency of the approach utilized in Group B that the
new laparoscopic techniques should be compared.</p>
[]
HPB Surg. 1992; 6(1):35-49