Simplification of Cryoprecipitate Coagulum Choledocholithotomy by Deletion of Thrombin: Prevention of Retained Biliary Duct Stones

• Conventional removal of stones from the biliary ducts can be difficult and may result in retained stones. We developed a modified tenacious coagulum that entraps biliary duct stones, resulting in a more complete extraction. Coagulum choledocholithotomy was simplified by mixing 20 parts of cryoprecipitate with one part of 10% calcium chloride solution without thrombin. Tenacious coagula were generated that had a tensile strength of 106 to 140 g/sq cm within three to six minutes and were 106% to 300% stronger than coagula with thrombin. This technique was performed on six patients. In each case, an intact coagulum that entrapped more calculi than were seen on the cholangiogram was extracted. This modified technique is simple, safe, nontraumatic, and achieves a more complete extraction of stones.