• A series of 1,381 initial biliary tract operations for calculous disease has been analyzed with respect to stones that escape detection during operation or form de novo after operation. The two kinds are often indistinguishable, and both are referred to as "retained stone." After 224 cholecystectomies with choledocholithotomy there were 14 cases of retained stone; after 1,156 cholecystectomies without choledochotomy there were only 9 cases of retained stone. Once the diagnosis of retained stone is established with reasonable certainty, reexploration is generally indicated. In this series, 22 patients under-went a second operation and four underwent a third. The unfortunate occurrence of retained stone is thus more frequently encountered after previous choledocholithotomy and the presence of a biliary duct stone indicates a possible source of serious difficulty.
Smith SW, Engel C, Averbook B, Longmire WP. PROBLEMS OF RETAINED AND RECURRENT COMMON BILE DUCT STONES. JAMA. 1957;164(3):231–236. doi:10.1001/jama.1957.02980030007002
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