Benign Biliary Disease: Management of Bile Duct Stones

Abstract

Biliary lithiasis is a widespread disease in the industrialized countries and is one of the most common reasons for abdominal surgery (Barbara 1984). Autopsy series and recent studies based upon clinical and instrumental investigations in selected groups or entire populations have revealed that the prevalence of the disease is much higher in females, and in both sexes rises with age (Bennion et al. 1979; Capocaccia and Ricci 1985; Covarrubias et al. 1983; Morino et al. 1988). In South-East Asia, stone disease characteristically involves the intrahepatic biliary tree and the common bile duct, sparing the gallbladder being often unaffected, and stones are of a mixed or inflammatory type (containing calcium bilirubinate and cholesterol). Although the exact etiology is still unknown, bile duct infection is believed to play a major role, either provoking lithiasis directly or causing duct strictures with subsequent formation of calculi. In Caucasians, on the other hand, more than 80% of stones are gallbladder or common bile duct stones composed of cholesterol; only a small proportion are found in the intrahepatic ducts (Maki et al. 1982).