Causes for 340 reoperations on the extrahepatic bile ducts

Three hundred forty of 5,086 patients undergoing operations on the extrahepatic biliary trees at the Swedish and University of Washington Hospitals in Seattle between 1956 and 1970 required reoperation on this system. This figure for reoperations did not include procedures for subhepatic or subphrenic abscess and/or wound complications. The most common cause for reoperation was an attempt to retrieve a residual or recurrent common duct stone (26.8% of the cases). The second most common cause for re-exploration was a tumor obstructing the common bile duct (18.9%). Less frequent causes for secondary surgery were stenosis of the ampulla of Vater (10.3%), bile duct injury (12.1%), pancreatitis (10.3%), inflammatory stricture (1.5%), cystic duct remnant (5%), and many other less important problems. Thus 4.7% or almost one in 20 of all our biliary operations were secondary. We feel that operative cholangiograms supplemented by manometry are the useful adjunct towards finding otherwise undetectable biliary pathology, whether on the basis of stones, tumors, or structures. We also feel that placement of T-tubes with a large arm going to the surface will allow the removal of most stones left behind after common bile duct explorations with the assistance of directable stone baskets.