Recent Trends in Diagnosis and Management of Choledocholithiasis

Abstract

Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10% of the adult population. CBDSs develops in about 8%-20% of patients having gallbladder stones, but in about 5% of cases the gallbladder is empty. One of the main reasons of investigating a patient with gallstones prior to cholecystectomy is to exclude the presence of associated CBD stones. All investigations are aimed at evolving a minimally invasive approach with the least number of complications achieved in a cost effectiveness manner to achieve a low overall morbidity of treatment. CBD stones are suspected if there is a history of pancreatitis or cholangitis, or there is increased serum levels of conjugated bilirubin, SGPT, SGOT and alk. phosph., or if there is dilatation of CBD more than 8mm or stone in the CBD at abdominal sonography or the presence of stones in the CBD at MRCP. The management of CBD stones traditionally required open laparotomy and bile duct exploration. With the advent of endoscopic and laparoscopic technology the main options for treatment are pre- or postoperative ERCP with endoscopic biliary sphincterotomy (EST), laparoscopic trans-cystic exploration of common bile duct and laparoscopic choledochotomy. The treatment of common bile duct stones has shown considerable evolution over the last 4 decades. The cause for this evolution has been constant up gradation of technological capability, which allows treating clinicians to offer cure.