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To assess the value of choledochoduodenostomy versus T-tube drainage to manage patients with recurrent choledocholithiasis, a prospective, randomized study was carried out where under strict criteria of selection, 45 patients underwent choledochoduodenostomy after choledochotomy (Group A), and another 45 patients underwent T-tube drainage (Group B). Results revealed that patients in Group A had low early morbidity (8.8 percent), no mortality, and no reoperations due to recurrent choledocholithiasis. In contrast, in Group B patients there was a mortality of 4.4 percent, an early morbidity of 26.6 percent, and a late recurrence and reoperation rate of 20.9 percent. The difference in those elements between patients in Group A and Group B is considered significant (p

Summary Experience with closure of the common duct after exploration for removal of calenli has been reviewed. The postoperative morbidity was less in the 250 patients having primary common duct closure than in a similar group of 250 patients subjected to T tube drainage. The conditions necessary for closure of the common bile duct after surgical exploration have been outlined. The indications for drainage of the common duct are also discussed. In the usual case primary closure of the common duct incision may be safely performed following exploration for calculi, but drainage is preferred in the presence of intensive inflammatory reaction involving the duct system and adjacent structures.

A patient is described who had acute perforation of a duodenal diverticulum and survived after surgical intervention. Various technics for the surgical management of perforated duodenal diverticula are detailed. Choledochotomy, with passage of a catheter or sound into the duodenum, permits identification of the ampulla and safe excision and closure of the diverticulum. T tube drainage seems to be useful, and postoperative cholangiography confirms the integrity of the duodenum prior to feeding. Drainage of the retroduodenal area is recommended.