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Techniques in treatment of retained gallstones.

A PANEL DISCUSSION of the treatment of retained gallstones precedes this editorial comment. Most investigators feel that approximately 5 percent of all patients in whom cholecystectomy is done will have retained gallstones in the extrahepatic bile ducts following the operation. If we assume that 600,000 cholecystectomies are carried out each year in the United States, there would be about 30,000 patients with retained stones in this coun-try, compared with the 3,000 or 4,000 mentioned by Dr. Longmire. Therefore, any discussion of the nine new modes of evaluation and treatment for common bile duct stones is timely. The nine new modalities are (1) ultrasound, (2) computerized axial tomography, (3) percutaneous transhepatic cholangiography with a small needle, (4) endoscopic retrograde cholangiopancreatography, (5) manometric cholangiography, (6) operative choledochoscopy, (7) dissolution of common bile duct stones with mono-octanoic acid, (8) removal of stones with a directable stone basket and (9) endoscopic papillotomy. It is appropriate to discuss the place of each modality in the preoperative, operative, early postoperative and late postoperative periods in relation to the diagnosis of gallbladder and common bile duct stones. Any of these modalities, with the exception of operative manometric cholangiography, choledochoscopy, and dissolution of intraductal stones by irrigating with a solution, can be used in the preoperative period and in the late postoperative period after all tubes are removed.