One per cent incidence of recurrent gallstones six to eight years after manometric cholangiography

Abstract

The national incidence of retained and recurrent common duct stones is between 2 and 7%. A prospective comparison of operative common duct pressure flow rates as opposed to operative cholangiography was commenced in 1968 to assay another diagnostic technique to assist in the reduction of this rather high incidence of recurrence. We are now reporting the 6-8 year follow-up data on the first 200 patients, 190 (95%) of whom were reevaluated in 1977. In our inital reports we were surprised to find that our accuracy with flow and pressure studies was 93%, not significantly different from that found with operative cholangiography (92%). The measurements of flow, resting pressure, and opening pressure in the patients with stones or strictures at the lower end of the bile duct were each significantly different from those found in normal ducts (p < 0.001). We considered normal flow to be 10 ml/min saline at 30 cm of pressure and normal intrabiliary pressure to be less than 16 cm of saline was measured through the cystic duct. To date only one individual has had to undergo reoperation for stones and another for recurrent biliary obstruction. A third individual is suspected of, but not proven, to have a retained stone. No patient who had a normal operative cholangiogram, flow and pressure studies, has had a late recurrence of stones. We have presented the specifications of a new catheter for performing flow and pressure x-ray studies, which we feel may be used to primarily evaluate the distal duct with greater accuracy and clarity. We think that this inexpensive but reliable method has an important place in biliary surgery, particularly where operative cholangiography may not be available, or, for one reason or, another, is not reliable.