Management of Common Bile Duct Stones: a Ten-Year Experience at a Tertiary Care Center

BACKGROUND: The authors present their experience with the treatment of cholecystocholedocholithiasis. METHODS: From August 1995 to August 2005, we treated 3750 patients with symptomatic gallbladder stones, and 12.7% of these patients also had a choledocholithiasis. This percentage with reference to the literature is certainly due to intraoperative cholangiography (IOC) performed routinely. During the follow-up, the percentage of residual versus recurrent stones was evaluated. RESULTS: Only 2 patients (3.1%) of the laparoscopic choledochotomy and cholecystectomy group had retained stones discovered at 5 and 11 months after surgery. These patients received ERCP with good results. No patients had leaks or fistulas. Only one patient died from a massive pulmonary embolism (1.6%). CONCLUSION: We believe that the key to successful management of patients with CBD stones is a well-standardized institutional procedural algorithm consistent with the available local resources and technologies.