Techniques for the treatment of common bile duct stones: A review

Abstract

Common bile duct stones (CBDSs) may occur in up to 6%10% of all adult patients for whom cholecystectomy is performed. Patients presenting with CBDS have symptoms including: biliary colic, jaundice, cholangitis, pancreatitis or may be asymptomatic. It is important to distinguish between primary and secondary stones, because the treatment approach varies. Stones found before, during, and after cholecystectomy had also different treatments. There is no consensus regarding the ideal management of concurrent gallbladder and CBD stones. Currently the treatment protocol involves most commonly a sequential approach consisting of endoscopic sphincterotomy followed by laparoscopic cholecystectomy or a single stage laparoscopic procedure, including cholecystectomy and exploration of the CBD (transcystic or transcholedochal approach). Endoscopic sphincterotomy has inherent morbidity and complications like CBD stone recurrence whereas laparoscopic CBD exploration demands considerable expertise which is available only at specialized centres. The clinical presentation of the patient,number of stones, size of CBD, available resources and technical expertise at hand are an important consideration for the ideal management in different conditions.