Management of Common Bile Duct Stones

Choledocholithiasis is a common condition that often requires a procedural intervention in order to treat. A number of different treatment strategies are employed when managing patients who present with choledocholithiasis. As such, the debate over the optimal management of these patients has persisted for many years. The currently available options include surgical intervention, most commonly with laparoscopic common bile duct exploration (LCBDE), endoscopic retrograde cholangiography with or without endoscopic sphincterotomy, and percutaneous transhepatic cholangiography. The choice of which option to pursue is dependent on patient-level considerations, including the presence of comorbidities that make the risk of surgical intervention prohibitive, in addition to the timing of diagnosis of choledocholithiasis. Furthermore, the level of support present in the health care facility to which the patient presents often dictates treatment options, given that the use of nonsurgical options requires the presence of endoscopic and/or interventional radiology capability. In this chapter, we review the various techniques available to clear the common bile duct of stones, with a focus on the use of LCBDE, including a discussion of the overall use of surgical approaches to the management of choledocholithiasis.