The Value of Choledochoscopy in Exploration of the Common Bile Duct

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Abstract
Direct visualization of the biliary tree using choledochoscopy has been recommended as a technique to improve the accuracy of common duct exploration. In several series the incidence of retained biliary calculi has been dramatically reduced using choledochoscopy, other unsuspected benign and malignant lesions were found as well. During an 8 yr period 288 patients underwent exploration of the common bile duct specifically for calculous disease. Operative rigid choledochoscopy was performed in 140 patients in this group, with 79 found to have choledocholithiasis; 7 retained stones occurred in this group for an incidence of 8.9%. Routine common duct exploration in the other 148 patients revealed 67 to have choledocholithiasis; 6 retained stones occurred in this group for an incidence of 9.0%. Though there was no difference in the incidence of retained stones with or without choledochoscopy, 20 patients had stones missed during routine exploration once the rigid choledochoscope was inserted. In addition to the obvious value of the choledochoscope in identifying and removing common duct stones, it was also an aid in removing stones in the intrahepatic ducts and in clarifying atypical anatomy. Other causes of biliary obstruction such as a liver fluke, benign polyp, benign strictures and ductal carcinomas were identified by use of biopsy forceps inserted through the choledochoscope. Routine choledochoscopy should be performed during common duct explorations and surgical residents should learn the technique of operative choledochoscopy.