Application of needle-type choledochotomy in laparoscopic common bile duct exploration / 国际外科学杂志

Objective:To introduce the usefulness and advantages of needle-type choledochotomy in laparoscopic common bile duct exploration.Methods:A retrospective analysis for the data of 1 107 patients who successfully implemented laparoscopic common bile duct exploration in Subei People′s Hospital of Jiangsu Province from January 1, 2013 to December 31, 2020 were applied. All cases were divided into the study group 662 cases with needle-type choledochotomy) and the control group (445 cases with non-needle-type choledochotomy) according to the manipulation of common bile duct incision. The time-cost, incidences of bleeding and bile leakage, as well as the recurrence rate of bile duct stone and the incidence of bile duct stenosis were observed and compared between the two groups. Normally distributed data were expressed as mean±standard deviation ( Mean± SD) and compared by t test while count data were expressed as frequency or percentage and compared by chi-square test or Fisher′s exact test. Results:The bile duct incision time and bleeding rate were (14.45±2.46) s and 25.1% in the study group, (104.48±15.32) s and 68.1% in the control group, respectively. The differences between the two groups were statistically significant ( P<0.001). The incidence of stone recurrence, biliary leakage, and bile duct stricture were 3.0%, 3.6% and 0.3% in the study group, 4.9%, 5.6% and 0.4% in the control group, respectively. There were no statistically significant differences between the two groups ( P>0.05). Conclusion:Needle-type bile duct incision can be used as a routine manipulation in laparoscopic common bile duct exploration for its time-saving, less bleeding, safe and easy to handling.

Coledocolitiasis insospechada en pacientes con litiasis vesicular / Unsuspected choledocholithiasis in patients with gallbladder stones

Antecedentes: actualmente un punto discutido de la colecistectomía laparoscópica (CL) es la realización sistemática de la colangiografía intraoperatoria (CIO); sin embargo, esta permite el diagnóstico de litiasis coledociana insospechada (LCI). Objetivo: establecer el porcentaje de CIO realizadas, el número de LCI diagnosticadas, describir qué terapéutica se utilizó para resolverlas y establecer si existe relación entre el tamaño de las litiasis diagnosticadas y su tratamiento transcístico. Resultados: de las 1077 CL electivas, la CIO pudo realizarse en el 89,14% de los pacientes. En 2014, el porcentaje de CIO fue el más alto de la serie (95,38%). Se encontraron 38 LCI. El tratamiento realizado incluyó el abordaje transcístico y la colangiopancreatografía retrógrada endoscópica (CPRE) intraoperatoria. La morbilidad global fue del 7,9 % sin mortalidad. Discusión: nuestro porcentaje de CIO se encuentra por debajo del enunciado en otras publicaciones, pero el porcentaje aumentó con los años. La incidencia de LCI en nuestro caso fue del 3,96%. En nuestro servicio primeramente se intenta la resolución transcística (tasa de éxito del 77,42% sin complicaciones). Otra opción es la CPRE intraoperatoria, que se utilizó en 4 casos con una eficacia del 100% sin complicaciones. Conclusión: el tratamiento de la LCI continúa siendo un reto para los cirujanos, debido sobre todo a la imprevisibilidad del cuadro; resulta un factor muy importante para la resolución transcística el tamaño de la litiasis encontrada (más o menos de 6 mm). Consideramos la CPRE intraoperatoria como una herramienta importante en la resolución de esta patología.

Background: currently a discussed point of laparoscopic cholecystectomy (LC) is the systematic implementation of intraoperative cholangiography (IOC); however, it allows the diagnosis of unsuspected common bile duct stones (UBDS). Objective: to establish the percentage of IOC performed, the number of UBDS diagnosed, to describe what therapeutic was used to solve them and to establish if there is a relationship between the size of the diagnostic lithiasis and the transcystic treatment of the same. Results: of the 1077 elective LC, IOC could be performed in 89.14% of patients. In 2014 the percentage of IOC was the highest in the series (95.38%). 38 UBDS were found. The treatment included the transcritical approach and intraoperative ERCP. Overall morbidity was 7.9% without mortality. Discussion: our IOC percentage is below the utterance in other publications, but the percentage has increased over the years. The incidence of UBDS in our case was 3.96%. In our service we first try the transcritical resolution (success rate of 77.42% without complications). Another option is intraoperative ERCP that was used in 4 cases with 100% efficacy without complications. Conclusion: the treatment of the UBDS continues being a challenge for the surgeons, mainly due to the unpredictability of the picture; a very important factor for transcystic resolution is the size of the stone found (more or less than 6 mm). We consider intraoperative ERCP as an important tool in the resolution of this pathology.

Anatomía quirúrgica del conducto colédoco: revisión de la clasificación topográfica / Surgical anatomy of the bile duct: revision of its topographical classification

Introducción: Se han clasificado diversas porciones del conducto colédoco, desde su origen en la unión cistohepática, hasta la segunda porción del duodeno. No se puede lograr un consenso al momento de segmentarlo, debido a que algunos autores sostienen la existencia de 3 o 4 porciones. Objetivo: El objetivo fue establecer la prevalencia de cada una de las porciones del conducto colédoco, determinar sus características morfológicas y analizar su asociación quirúrgica. Material y método: Estudio analítico de corte transversal en el que se diseccionaron 40 vías biliares. Resultados: Se evidenció 85% de porción retroduodenal, 20% retropancreática, 80% intrapancreática y 45% intramural. No se evidenció la porción supraduodenal debido a las relaciones anatómicas regionales, al tabique cistohepático o a una unión cistohepática baja. La combinación secuencial más frecuente fue la retroduodenal e intrapancreática. El conducto colédoco tuvo una longitud de 66,19 mm y un diámetro de 6,31 mm. Conclusiones: La segmentación biliar establecida tendría implicancias tanto teóricas, al justificar las teorías etiopatogénicas vigentes de la pancreatitis biliar, como prácticas, redefiniendo la coledocotomía supraduodenal y los cuadros clínicos de ictericia obstructiva.

Introduction. Several portions of the bile duct have been classified from its origin in the cystohepatic junction to its outfall in the second portion of the duodenum. An agreement could not be reached among the authors at the time of segmenting it, since some of them claim that there are three or four portions. Objective. To establish the prevalence of each of the bile duct portions, determine its morphological characteristics and to analyze its surgical associations. Material and method. A cross-sectional study. 40 biliary tracks were dissected. Results: Retroduodenal portion 85%, retropancreatic 20%, intrapancreatic 80%, intramural 45%. The supraduodenal portion was not made evident because of the regional anatomic relations, the cystohepatic septum or a cystohepatic lower junction. The bile duct had an average lenght of 66.19 mm and a diameter of 6.31 mm. Conclusions: The biliary segmentation would have a theoretical explanation to justify the etiopathogenic theories of the biliary pancreatitis, and a practical implication by redefining the choledochotomy supraduodenal and clinical pictures of obstructive jaundice.

Effect of External Biliary Drainage via Cystic Duct in Laparoscopic Choledochotomy with Primary Closure / 中国微创外科杂志

Objective To investigate the effectiveness and safety of the slender external biliary drainage tube (F5 ureter catheter) inserted into the common bile duct via the cystic duct in laparoscopic choledochotomy with primary closure.Methods Clinical data of 59 patients with cholecystolithiasis and choledocholithiasis treated in our hospital between Feburary 2013 and March 2016 were retrospectively analyzed.The patients were treated with laparoscopic common bile duct exploration followed by primary duct closure,and bile duct drainage with a slender catheter through cystic duct after closure of the choledochotomy.Results All the cases underwent surgery successfully.The postoperative output of bile drainage was 30-570 ml/d.There were no complications such as biliary leakage,cholangitis or biliary pancreatitis.The catheter was withdrawn in 6-8 d in 57 patients after the operation,and was withdrawn in 10-11 d in 2 patients after the operation.There was no discomfort after removing the catheter.Postoperative hospitalization time was (9.1 ± 2.0) d.All patients were followed up for 5 months to 3 years,with an average of 16 months.The B ultrasound examinations showed no residual bile duct stones and liver functions were normal.Conclusions External biliary drainage using a slender ureter catheter via the cystic duct is safe,effective and easy to perform.It may reduce postoperative potential complications,especially bile leakage.

Primary closure after laparoscopic choledochotomy with transcystic cholangiography and biliary drainage / 中华肝胆外科杂志

Objective To assess the clinical outcomes in patients who underwent laparoscopic primary closure of common bile duct (CBD) with or without transcystic cholangiography and transcystic biliary drainage.Methods From June 2013 to March 2016,we operated on 46 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy (group A).The results were compared with 51 patients who underwent primary closure of common bile duct after laparoscopic choledochotomy together with transcystic biliary drainage (group B) during the same study period.Results There was a significant difference in the incidence of postoperative bile leakage between the two groups.The risk in group A was sig nificantly higher than group B (8.7％ vs 0％,P ＜0.05).The duration of operation in group A was significantly shorter than in group B [(125.3 ± 28.3) min vs (131.3 ± 20.5) min].There were no significant differences in the duration of hospital stay between the two groups [(7.3 ± 2.4) days vs (7.8 ± 1.9) days,P ＞ 0.05].All patients were followed up (range 3 months to 29 months,average 8.4 months).B-ultrasound examination showed no residual bile duct stones and the liver functions were normal.Conclusions Laparoscopic primary closure of common bile duct was possible after choledochotomy.Transcystic cholangiography and transcystic biliary drainage after primary closure of common bile duct were safer and more reli able.

Litiasis de la vía biliar principal: resultados del tratamiento quirúrgico y de la papilotomía endoscópica / Common bile duct lithiasis. Results of surgical treatment andendoscopic papilotomy

ANTECEDENTES: Las posibilidades de coexistencia de cálculos en la vía biliar principal (VBP) al mismo tiempo que en la vesícula son del orden del 10 al 20%; su tratamiento es muy importante para evitar las complicaciones de la obstrucción ductal –ictericia y colangitis– y la pancreatitis aguda. Las distintas modalidades de tratamiento buscan reducir al máximo las complicaciones al tiempo de lograr la eficacia máxima, determinada fundamentalmente por la completa evacuación de los cálculos en los conductos. OBJETIVO: evaluar las complicaciones y/o litiasis residual en pacientes con litiasis de la vía biliar, tratados quirúrgicamente –coledocotomía– o por vía endoscópica (esfinterotomía), controlados durante 1 año.Pacientes y método: Estudio analítico de cohortes retrospectivo; Grupo A=50 pacientes operados, con edad promedio de 48 años y Grupo B=50 pacientes con tratamiento endoscópico, con edad promedio de 49 años. El diámetro de la VBP fue de 12.5 y 11.4 mm en los grupos respectivos y el diámetro de los cálculos 18 y 9.2 mm, respectivamente. Fueron evaluados: tiempo de internación, complicaciones y resolución definitiva de la litiasis, evaluada mediante un seguimiento de 1 año. RESULTADOS: Las complicaciones se encontraron en 10% y 18% en los grupos A y B, respectivamente; el tiempo de internación post procedimiento fueron 7.2 y 3.6 días. El éxito terapéutico fueron 96 y 80% respectivamente. CONCLUSIONES: las ventajas de la esfinterotomía se limitan a un tiempo de internación más breve, pero con mayor frecuencia de complicaciones.

BACKGROUND: The potential coexistence of stones in the bile duct while in the gallbladder are on the order of 10 to 20% treatment is important to prevent the complications of ductal obstruction –jaundice and cholangitis– and acute pancreatitis. The different treatment modalities seek to minimize complications at the time of maximum essentially determined by the complete removal of stones in the ducts effectively. OBJECTIVE: To evaluate complications and / or residual calculi in patients with gall stones Road, treated surgically - choledochotomy - or endoscopically ( sphincterotomy ), controlled for 1 year. PATIENTS AND METHODS: A retrospective cohort study analytical; Group A= 50 patients operated with an average age of 48 years and Group B= 50 patients with endoscopic treatment, with a mean age of 49 years. VBP diameter was 12.5 and 11.4 mm in the respective groups, and calculate the diameter of 18 and 9.2 mm, respectively. Were evaluated: length of stay, complications and final resolution of the stone, as assessed by a 1-year follow-up. RESULTS: Complications were found in 10% and 18% in groups A and B, respectively; procedure time post hospitalization were 7.2 and 3.6 days. Treatment success was 96 and 80% respectively. CONCLUSIONS: The advantages of EE are limited to a shorter hospitalization time but with greater frequency of complications. Keywords: Choledocholithiasis bile duct. Choledochotomy. Endoscopic sphincterotomy.

Safety evaluation of laparoscopic common bile duct exploration and lithotomy without placing drainage tube / 中华消化外科杂志

Objective To investigate the safety of laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively.Methods Forty patients who received laparoscopic common bile duct exploration and lithotomy at the Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from January 2011 to June 2013 were prospectively analyzed.All the patients were randomly divided into 2 groups according to the random number table.Twenty patients in the experimental group did not received drainage tube placement,and the other 20 patients in the control group had subhepatic drainage after operation.The operation time,duration of hospital stay and incidence of postoperative complications were compared between the 2 groups.Patients received computed tomography and B sonography at postoperative month 1 and 3,and then patients were reexamined every 6 months till postoperative year 3.The follow-up was ended on July 31,2013.The measurement data and the count data were analyzed using the independent sample t test and the Fisher exact probability,respectively.Results Patients in the 2 groups were cured after the operation.The operation time and duration of hospital stay were (117 ± 11) minutes and (5.6 ± 0.6) days in the experimental group,and (108 ± 12)minutes and (7.9 ± 0.7)days in the control group,with significant difference between the 2 groups (t =2.453,-ll.388,P ＜ 0.05).No complications including bile leakage,residual stones,obstructive jaundice,abdominal bleeding and subphrenic infection were detected after the operation.Thirty-one patients were followed up for 1 month to 2 years,no bile duct stone recurrence or biliary stricture were detected during the follow-up.Conclusion Laparoscopic common bile duct exploration and lithotomy with primary closure and without placing drainage tube postoperatively is safe and feasible.

Application of Laparoscope with Choledochoscope in Treatment of Cholangiolithiasis / 昆明医科大学学报

Objective To discuss the way of treatment of bile duct stone with laparoscope and choledochoscope. Methods Forty six patients with bile duct stones admitted in our hospital from July 2001. to July 2008 were selected in this study. The 46 cases were divided into two groups:the control and observation group.The control group included 22 patients who were performed cholecystectomy and choledochotomy with T tube drainage. The obeservation group included 24 patients who were performed laparoscope and choledochoscope operation.We used the Mann-Whites statistics and compared the incidence of complications, the amount of bleeding and hospitalized days in patients between two groups. When P<0.05, the difference between the two groups was considered statistically significant. Results The incidence of complications after operation, amount of bleeding and hospitalized days in patients had no statistically significant difference between two groups. The time of operation in observation group was longer than control group. The bile stones eradication rate in observation group was higher than control gourp. and the bile stones recurring rate in observation group was lower than control gourp. Conclusion It is better to treat the bile duct stones by using laparoscope with choledochoscope than the way of traditional cholecystectomy and choledochotomy with T tube drainage, the former has advantages such as higher bile duct stones edarication rate, lower recurring rate, safer and more reliable operation and fewer complications.

Ten-year experience on common bile duct exploration without T-tube insertion

BACKGROUNDS/AIMS: Common bile duct (CBD) exploration has been a procedure necessary to remove stones which are not removable by endoscopic sphincterotomy (EST). T-tube was installed mainly in the concern of bile leakage after procedure. But T-tube itself can only cause bile peritonitis and thus, prolonged discomfort and care after operation. In addition, in the era of laparoscopy, T-tube insertion adds much operation time and is technically difficult for installation during the procedure. METHODS: Our case of open cholecystectomy and primary closure of CBD not leaving T-tube (n=28, group I) with reports dating from July 1998 to June 2007 is presented here to see whether primary closure without T-tube is safe as compared with T-tube inserted cases performed at the same center (n=15, group II). Operative cholangiography, CT scan, ultrasound and biochemical data were followed up for both groups and surveyed on operative complications as well to determine the outcomes. RESULTS: Bile leakage in 1, recurrent stone in 2 and obstructive jaundice in 1 were all considered during the follow up period among 28 group I patients (n=6), when compared to T-tube inserted group II patients with 2 bile peritonitis, 1 residual stones and 1 pancreatitis (n=4), showing no meaningful differences (p=0.07). CONCLUSIONS: CBD exploration and direct primary closure not leaving T-tube is an acceptable operational option as recently tried in many choledochotomies.

Primary suture of common bile duct after exploration / 国际外科学杂志

Objective To study the feasibility, indications and clinical value of primary suture after the common bile duet exploration(CBDE).Methods One hundred and fimr cases of choledocholithiasis were chosen for primary suture by 5-Oviger after CBDE. Post-operative complications and the length of hospital stay were compared with those with T-tube drainage. Results Compared with T-tube drainage group, the complication rate was reduced and the length of hospital stay in primary suture group was shortened. And also the mortality and operation time were decreased significantly. Conclusion The primary suture after CBDE in selected oases is safe and reliable.

Comparison of Primary Closure and T-tube Drainage following Laparoscopic CBD Exploration

PURPOSE: Laparoscopic common bile duct exploration (LCBDE) has traditionally been accompanied by T-tube drainage. However, patients must carry it for several weeks and often suffer problems related to the T-tube. So, primary closure of CBD has been proposed as a safe and effective alternative to T-tube placement after laparoscopic choledochotomy. The aim of this study was to compare primary closure versus T-tube drainage after LCBDE. METHODS: Between January 2000 and December 2005, 63 patients suffering from choledocholithiasis underwent LCBDE successfully through choledochotomy. Those patients were devided into two groups; primary closure group (group P) and T-tube placement group (group T). Patients' clinical characeristics, postoperative outcome and follow up data were compared between the two groups. RESULTS: Of 63 patients, 30 (48.6%) had primary closure of the choledochotomy and 33 (52.4%) had T-tube drainage. Stone clearance rate was 100% in both groups. The mean operation time and the incidence of postoperative complications had no significant difference between the two groups. The mean postoperative hospital stay (8.8 vs. 16.4 days, P<0.001) was significantly shorter in the P group compared to the T group. Each group had one recurrent CBD stone. None of both groups showed symptoms or signs associated with CBD stricture during the follow up period. CONCLUSION: Primary closure of choledochotomy after LCBDE can prevent the disadvantages associated with T-tube and lead to a shorter hospital stay. Therefore, primary closure should be considered as a safe alternative method after LCBDE.

Comparison of Clinical Characteristics between Primary Closure of Common Bile Duct and T-tube Drainage after Choledochotomy / 한국간담췌외과학회지

BACKGROUND/AIMS: In the management of choledocholithiasis, T-tube drainage was the most common treatment modality after common bile duct (CBD) exploration. However, the T-tube drainage has several problems and risk of complications such as abdominal discomfort, long duration of drainage, or bile leakage. We evaluated the effectiveness of primary closure of CBD after choledochotomy and the possibility of substitution for T-tube drainage. METHODS: Seventy six patients with choledocholithiasis who had undergone CBD exploration were enrolled in this study from January 1999 to March 2001. 20 patients among them had undergone primary closure of CBD with preoperative endoscopic nasobiliary drainage (ENBD) or percutaneous transhepatic biliary drainage (PTBD) in situ after exploration (primary closure group), 56 patients had undergone T-tube drainage (T-tube group). We compared the clinical characteristics and outcome between two groups. RESULTS: There was no difference in postoperative complication (19.6% vs. 20%), the mean amount of biliary drainage (326 ml/day vs. 320 ml/day) and the duration of hospitalization (11.6 day vs. 9.2 days) between the both groups. The duration of biliary drainage was significantly longer in the T-tube group (45.3 days) than in the primary closure group (9.2 days; p<0.01). The rate of remnant stone was higher in the T-tube group (32.1%) than the primary closure group (20%), there was not statistically significant. CONCLUSION: The primary closure of CBD with the preoperative biliary drainage was relatively safe and resulted in no difference of clinical outcome. Furthermore, this method induced going back early to normal life. These result suggest that the primary closure of CBD may be a feasible technique after choledochotomy when the patients are selected by specialized indications.

Clinical Consideration of Choledocholithiasis Treatment: Analysis of Primary Closure versus T-tube Drainage after Choledochotomy

PURPOSE: The placement of a drainage tube in the common bile duct, following a choledochotomy, has become accepted as routine procedure since it was first reported, by Abbe, in 1892. However, many complications are associated with T-tube drainage, such as bile peritonitis after its removal, accidental dislodgement, bile leakage from the T-tube track and a high incidence of postoperative bacteremia, have been reported. This study was designed to evaluate the primary closure as a suitable surgical technique in placce of T-tube drainage following a choledochotomy METHODS: Between January and December 2002, primary closures were performed in 41 cases and T tube drainage in 112, following a choledochotomy. These cases were divided into 2 groups (group A: primary closure, and group B: T-tube drainage). The medical records of the patients were reviewed, and the following data analysed -age, sex, preoperative laboratory value, intraoperative finding, postoperative laboratory value, complication, and days of postoperative hospital stay. RESULTS: There were no significant differences observed in the data of the investigated parameters, with the exception of the mean post-operative hospital stay. The mean post- operative hospital stays were 11.82 and 18.08 days in groups A and B (P=0.0034), respectively. The complication rates of each group showed no statistical difference. However bile peritonitis or bile leakage after T-tube removal developed 5 cases from group B. There were 2 and 5 deaths due to MODS & ARDS, respectively. CONCLUSION: A primary closure, following a choledochotomy, may be a suitable alternative technique to T-tube drainage under reasonable conditions.

Study on the primary closure of bile duct incision of laparoscopic bile duct exploration and balloon dilatation catheter dilatation / 中华消化内镜杂志

Objective To discuss the indications and complications of primary closure of bile duct incision in laparoscopic bile duct exploration and balloon dilatation catheter dilatation to treat the papillary stenosis and the intrahepatic bile duct stenosis. Methods A pospective study of 42 ptients of bile duct incision closure primary in laparoscopic bile duct exploration and balloon dilatation catheter dilatation, laparoscopic bile duct exploration and extraction of bile duct stones with choledochotomy was first adopted in order to clear the stones, then followed by the balloon dilatation catheter(explosive pressure reached 2020 kPa, used 505kPa) to dilate the papillary stenosis and the intrahepatic bile duct stenosis (CT-7542～ CT-75104) until the stenosis was released. Whether the primary closure of duct incision was selected or not, it was based on the situation of intraoperative choledochoscopic exploration, if it had been selected, the closure of bile duct incision would accepted by using absorbable suture 4-0 or 5-0, without placing bile duct drainage.It was routinely to place the drainage tube in the oriffice of the lesser omentum. Results 41 out of 42 patients had obtained successful duct clearance, the dilatation of the stenosis to reach the expected expansion and without bile leakage. One patient had bile leakage about 30-150 ml daily persisted for 4 days through cured conservatively. Conclusion Eventually it was safe and effective for some patients who had completed successful duct clearance and the dilatation of the stenosis to reach the expected expansion with the balloon dilatation catheter. They were adopted to the primary closure of duct incision using absorbable suture and did not need to place bile duct drainage.

Comparison of pressure changes in the common bile duct after laparoscopic common bile duct exploration with primary closure of bile duct or Ttube biliary drainage / 中国微创外科杂志

Objective To compare common bile duct pressure changes after laparoscopic common bile duct exploration between primary closure of the bile duct and T-tube drainage.Methods Postoperative common bile duct pressure changes were analyzed in 30 cases of laparoscopic common bile duct exploration,including 15 cases of primary suture of the bile duct and 15 cases of T-tube biliary drainage respectively,from August 2003 to January 2004 in this hospital.Results ①The hydrostatic pressure in common bile duct was 6.0~18.5 cm H_2O(0.54~1.66 kPa).②As compared with preoperative levels,the common bile duct pressure increased slightly on the first postoperative day and decreased significantly on the fifth postoperative day in primary suture cases(q=4.531,P

Clinical investigation of laparoscopic biliary re-operations / 中国微创外科杂志

Objective To investigate the feasibility and techniques of laparoscopic biliary re-operations. Methods Laparoscopic surgery was performed in 13 patients with bile duct stones who already had undergone biliary tract operations. Results Laparoscopic choledochotomy was successfully completed in 12 cases, while a conversion to open surgery was required in 1 case. The success rate of laparoscopic surgery was 92.3% (12/13). The operation time was (101～300) min, with a mean of 155 min. No intra- or post- operative complications occurred. Conclusions Laparoscopic biliary re-operations are feasible and experiences are needed to ensure the success of surgery.

A Clinical Analysis of Open T-tube Choledochostomy

Traditionally, open choledochotomy with T-tube choledochostomy had been considered as the "gold standard" for choledocholithiasis. Recently, the frequency of performing the open choledochotomy with T-tube choledohostomy has decreased due to the progression of several less invasive procedures and laparoscopic technques, but until now open choledochotomy with T-tube choledochostomy is the most popular procedure in choledocholithiasis. Therefore we reviewed 126 cases who were treated with open choledochotomy with T-tube choledochostomy from January 1987 to June 1996 at our institution in order to inspect the several problematic points especially after T-tube removal. The results are summarized as follows, 1) The sex ratio of male to female was 1:1.29, and the average age was 59.6 years old. 2) 119 cases (94.4%) were biliary tract stone disease and 7 cases (5.6%) were non-calculous benign biliary tract disease. The most common etiologic disease was GB and CBD stone (37.3%). 3) Most of postoperative T-tube cholangiography was performed within 14 days (84.1%). 4) The number of patients containing some residual stone at postoperative T-tube cholangiography was 29 cases (23%). 14 of these patients were treated by Dormia-basket stone removal and its success rate was 85.7%. 5) The T-tube was removed within 2 months in 109 cases (86.5%). 6) The number of complications after T-tube removal were 8 cases (6.3%). All of them had bile peritonitis symptomes, and three of them were treated by reoperation. 7) The postoperative complications were noted in 27 cases (21.4%). and the most frequent complication is wound infection (25.8%). The postoperative mortality was noted in 1 case (0.8%).