Management of Common Bile Duct Stones

Common bile duct stones (CBDS), or choledocholithiasis, is simply the presence of stones in the common bile duct (CBD) and may present as an incidental finding on imaging or with symptomatic biliary obstruction, including various sequelae, such as acute pancreatitis and ascending cholangitis. Surgeons should maintain a high index of suspicion for CBDS when managing patients with other biliary pathology and should collaborate closely with gastroenterology colleagues for CBD clearance, which is most commonly achieved with endoscopic retrograde cholangiopancreatography (ERCP). However, all general surgeons should be familiar with the operative management of CBDS as well, as ERCP is unsuccessful in as many as 10% to 20% of cases.