Experience with the Flexible Fiberoptic Choledochoscope

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Abstract
Despite significant effort on the part of surgeons, the incidence of retained calculi after common duct exploration still remains unacceptably high. The best way to reduce the incidence of retained calculi would probably be a more complete exploration of the common duct at the time of the initial operation. The experience with a flexible fiber optic endoscope used intraoperatively in 52 patients and postoperatively in 1 case to visualize the intrahepatic and extrahepatic bile ducts, is reported. In addition to visualization of stones, the choledochoscope has a channel through which various instruments can be passed to facilitate stone removal. Flexible choledochoscopy was performed 53 times in 52 patients between Jul. 1978-Nov. 1980. In 1 patient, the choledochoscope was used to explore the bile ducts via the T-tube tract after operation. In 52 patients, the scope was used intraoperatively: 2 patients demonstrated bile duct tumors, in 14, stones were not found on exploration. Of these, 1 had stenosis at the papilla of Vater and 1 had external compression of the duct by a pancreatic pseudocyst. All of these findings were confirmed by choledochoscopy, in 26 patients choledochoscopy confirmed complete surgical removal of all stones, in 6 patients, multiple stones were removed using routine common duct exploration but additional stones were seen with the choledochoscope, in 3 patients no stones were retrieved on routine duct exploration but were seen using the choledochoscope. In 8 cases stones were grasped or crushed using the accessories of the choledochoscope. In 1 patient calculi were missed by routine surgical exploration and choledochoscopy. No septic complications were seen in any of these patients.