Simplification of cryoprecipitate coagulum choledocholithotomy by deletion of thrombin. Prevention of retained biliary duct stones

An improved double-lumen biliary catheter for cholangiography

A double-lumen biliary catheter was developed to aid in the performance of cholangiography and bile duct stone extraction. A prototype catheter was used in four cadavers. Excellent cholangiograms were obtained and a cryoprecipitate coagulum easily formed in the bile ducts without waste. Extraction of the coagulum from the bile ducts was aided by use of the catheter. The catheter also can aid in routine balloon catheter bile duct stone extraction, and thus is useful for both diagnosis and treatment of bile duct stones.

Coagulum pyelolithotomy: impact on unrecognized stones

The use of coagulum free of thrombin to remove 313 renal calculi from 46 patients is reviewed. Twenty-six additional calculi removed from 17 patients were not apparent on preoperative studies. Of the 313 stones apparent preoperatively 3 were not extracted in the coagulum. Other means (stone forceps and so forth) were used to deliver 2 of these calculi and 1 was left in the kidney. Incisions used for these procedures included the conventional flank incision in 9 patients, a 10 cm. posterior flank incision in 30 and lumbotomy in 7. Adjunctive use of coagulum in 8 additional patients is presented. The recovery of more than the preoperatively identified renal calculi may be an advantage for coagulum pyelolithotomy. The length of hospital stay in these 46 patients averaged 4.8 days, with an average operative time of 1.22 hours. The patients returned to work within an average of 13 days. We suggest that these data are comparable to other methods of pyelonephrolithotomy.