Recurrent bile duct stones after transduodenal sphincteroplasty.

ABSTRACT

BACKGROUND: Transduodenal sphincteroplasty (TDS) offers permanent prophylaxis against further stones in the common bile duct (CBD) by allowing continuous free efflux of bile from the papilla. PATIENTS AND RESULTS: In a personal series of 267 consecutive operations, four patients underwent further treatment for recurrent CBD stones during a median follow-up of 12 years. Three of them received Roux-en-Y biliary diversion and had no further symptoms; the fourth patient remains well four years after endoscopic extraction of stones. DISCUSSION: Recurrent stone formation is rare after an adequate TDS and probably reflects retained food debris within the CBD. Initial treatment may be endoscopic, but biliary diversion is needed for those with recurrent symptoms.