Common Bile Duct Stones in Cholecystectomized Patients

  • Carmelo Sciumè
  • Girolamo Geraci
  • Franco Pisello
  • Tiziana Facella
  • Francesco Li Volsi
  • Giuseppe Modica


The incidence of retained or primary stones is approximately 2–5% after conventional and laparoscopic cholecystectomy (LC) and 5–15% after common bile duct exploration (CBDE) [1]: in principle these patients are in need of further intervention [2, 3].


Bile Duct Common Bile Duct Stone Bile Duct Stone Endoscopic Sphincterotomy Common Bile Duct Exploration 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Blumgart LH (2007) Surgery of the liver, biliary tract and pancreas, IV edn, vol 1. Saunders ElsevierGoogle Scholar
  2. 2.
    Roslyn JJ, Binns GS, Hughes EF et al (1993) Open cholecystectomy. A contemporary analysis of 42, 474 patients. Ann Surg 218:129–137PubMedCrossRefGoogle Scholar
  3. 3.
    Berci G, Cuschieri A (1997) Bile duct and bile duct stones. Philadelphia, WB Saunders CompanyGoogle Scholar
  4. 4.
    Gerwig WH jr, Countriman LK, Gomez AC (1961) Congenital absence of gallbladder and cystic duct: report of 6 cases. Ann Surg 153:113–125PubMedGoogle Scholar
  5. 5.
    Dandan IS, Soweid AM, Abiad F (2003) Choledocholithiasis. In: Plantz SH (ed) eMedicine (web based reference textbook)Google Scholar
  6. 6.
    Saharia PC, Zuidema G, Cameron JL (1977) Primary common duct stones. Ann Surg 185:598–602PubMedCrossRefGoogle Scholar
  7. 7.
    Madden JL (1973) Common duct stones; their origin and surgical management. Surg Clin North Am 53:1095–1113PubMedGoogle Scholar
  8. 8.
    Kim DI, Kim MH, Lee SK et al (2001) Risk factors for recurrence of primary bile duct stones after endoscopic sphincterotomy. Gastrointest Endosc 54:42–48PubMedCrossRefGoogle Scholar
  9. 9.
    Legorreta A, Brooks RJ, Staroscik RN et al (1995) Increased ERCP rate following the introduction of LC. J Laparaendosc Surg 5:271–278Google Scholar
  10. 10.
    Uchiyama K, Honishi H, Tani M (2003) Long-term prognosis after treatment of patients with choledocholithiasis. Ann Surg 238:97–102PubMedCrossRefGoogle Scholar
  11. 11.
    Christoforidis E, Goulimaris I, Kanellos I et al (2002) The role of juxtapapillary duodenal diverticula in biliary stone disease. Gastrointest Endosc 55:543–547PubMedCrossRefGoogle Scholar
  12. 12.
    Chandy G, Hart WJ, Roberts-Thomson IC (1997) An analysis of the relationship between bile duct stones and periampullary duodenal diverticula. J Gastroenterol Hepatol 12:29–33PubMedCrossRefGoogle Scholar
  13. 13.
    Caddy GR, Tham TC (2006). Symptoms, diagnosis and endoscopic management of common bile duct stones. Best Pract Res Clin Gastroenterol 20:1085–1101PubMedCrossRefGoogle Scholar
  14. 14.
    Tse F, Barkun JS, Barkun AN (2004) The elective evaluation of patients with suspected choledocholithiasis undergoing LC. Gastrointest Endosc 60:437–448PubMedCrossRefGoogle Scholar
  15. 15.
    Romagnuolo J, Bardou M, Rahme E et al (2003) Magnetic resonance cholangiopancreato-graphy: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 139:547–557PubMedGoogle Scholar
  16. 16.
    David V, Reinhold C, Hochman M et al (1998) Pitfalls in the interpretation of MR cholangiopancreatography. AJR Am J Roentgenol 170:1055–1059PubMedGoogle Scholar
  17. 17.
    de Ledinghen V, Lecesne R, Raymond JM et al (1999). Diagnosis of choledocholithiasis: EUS or magnetic resonance cholangiography? A prospective controlled study. Gastrointest Endosc 49:26–31PubMedCrossRefGoogle Scholar
  18. 18.
    Verma D, Kapadia A, Eisen GM et al (2006) EUS vs MRCP for detection of choledocholithiasis. Gastrointest Endosc 64:248–254PubMedCrossRefGoogle Scholar
  19. 19.
    Maniatis P, Triantopoulou C, Sofianu E et al (2003) Virtual CT cholangiography in patients with choledocholithiasis. Abdom Imaging 28:536–544PubMedCrossRefGoogle Scholar
  20. 20.
    Christoforidis E, Vasiliadis K, Goulimaris I et al (2004) Endoscopic management of retained bile stones with an indwelling T-tube. Surg Endosc 18:1582–1586PubMedGoogle Scholar
  21. 21.
    Mazzariello RM (1978) A fourteen-year experience with nonoperative instrument extraction of retained bile duct stones. World J Surg 2:447–455PubMedCrossRefGoogle Scholar
  22. 22.
    Tritapepe R, Caspani P, Pozzi C (1988) Postoperative trans-T-tube cholangiography: possibilities of false-negatives in residual calculi. Minerva Chir 43:867–870PubMedGoogle Scholar
  23. 23.
    Josephs LG, Birkett DH (1992) Laser lithotripsy for the management of retained stones. Arch Surg 127:603–604PubMedGoogle Scholar
  24. 24.
    Hammarström LE, Stridbeck H, Ihse I (1996) Long-term follow-up after endoscopic treatment of bile duct calculi in cholecystectomized patients. World J Surg 20:272–276PubMedCrossRefGoogle Scholar
  25. 25.
    Sciumè C, Pisello F, Geraci G et al (2001) Multiple choledocholithiasis. Ann Ital Chir 72:473–476PubMedGoogle Scholar
  26. 26.
    Cotton PB, Vallon AG (1980) Post-cholecystectomy ERCP. Lancet 29:1–710Google Scholar
  27. 27.
    Soehendra N, Kempeneers I, Eichfuss HP et al (1981) Early post-operative endoscopy after biliary tract surgery. Endoscopy 13:113–117PubMedCrossRefGoogle Scholar
  28. 28.
    Escourrou J, Cordeva JA, Lazorthes F et al (1984) Early and late complications after endoscopic sphincterotomy for biliary lithiasis with and without the gall bladder ‘in situ’. Gut 25:598–602PubMedCrossRefGoogle Scholar
  29. 29.
    Simpson CJ, Gray GR, Gillespie G (1985) Early endoscopic sphincterotomy for retained common bile duct stones. J R Coll Surg Edinb 30:288–289PubMedGoogle Scholar
  30. 30.
    O’Doherty DP, Neoptolemos JP, Carr-Locke DL (1986) Endoscopic sphineterotomy for retained common bile duct stones in patients with T-tube in situ in the early postoperative period. Br J Surg 73:454–456PubMedCrossRefGoogle Scholar
  31. 31.
    Lambert ME, Martin DF, Tweedle DE (1988) Endoscopic removal of retained stones after biliary surgery. Br J Surg 75:896–898PubMedCrossRefGoogle Scholar
  32. 32.
    Bickerstaff KI, Berry AR, Chapman RW, Britton J (1988) Early postoperative endoscopic sphincterotomy for retained biliary stones. Ann R Coll Surg Engl 70:350–351PubMedGoogle Scholar
  33. 33.
    Askew AR, Ward M, Cowen AE (1989) Early postoperative endoscopic sphincterotomy for retained common duct stones. Ann R Coll Surg Engl 71:359–360PubMedGoogle Scholar
  34. 34.
    Danilewitz MD (1989) Early postoperative endoscopic sphincterotomy for retained common bile duct stones. Gastrointest Endosc 35:298–299PubMedCrossRefGoogle Scholar
  35. 35.
    Tandon RK, Nijhawan S, Arora A (1990) Management of retained common bile duct stones in patients with T-tube in situ: role of endoscopic sphincterotomy. Am J Gastroenterol 85:1126–1131PubMedGoogle Scholar
  36. 36.
    Nussinson E, Cairns SR, Vaira D et al (1991) A 10 year single centre experience of percutaneous and endoscopic extraction of bile duct stones with T tube in situ. Gut 32:1040–1043PubMedCrossRefGoogle Scholar
  37. 37.
    Ovartlarnporn B, Piratvisuth T, Wacharasin R et al (1992) Endoscopic removal of stone in patients with retained common bile duct stone and T-tube after cholecystectomy. Is it justified? J Med Assoc Thai 75:524–528PubMedGoogle Scholar
  38. 38.
    Abu-Khalaf A (1995) Endoscopic removal of retained common bile duct stones in patients with T tube in situ. Surg Laparosc Endosc 5:17–20PubMedGoogle Scholar
  39. 39.
    Cheung MT (1997) Postoperative choledochoscopic removal of intrahepatic stones via a T tube tract. Br J Surg 84:1224–1228PubMedCrossRefGoogle Scholar
  40. 40.
    Gamal EM, Szabò A, Szule E et al (2001) Choledochoscopic treatment of retained biliary stones via dilated T-tube tract. Surg Endosc 15:473–476PubMedCrossRefGoogle Scholar
  41. 41.
    Sciumè C, Geraci G, Pisello F et al (2003) Endoscopic removal of a Dormia basket impacted in the biliary tract during treatment of a difficult residual choledocholithiasis. Report of a case. Ann Ital Chir 74:209–212PubMedGoogle Scholar
  42. 42.
    Cotton PB (1984) Endoscopic management of bile duct stones (apples and oranges). Gut 25:587–597PubMedCrossRefGoogle Scholar
  43. 43.
    Varadarajulu S, Eloubeidi MA, Wilcox CM et al (2006) Do all patients with abnormal intraoperative cholangiogram merit endoscopic retrograde cholangiopancreatography. Surg Endosc 20:801–805PubMedCrossRefGoogle Scholar
  44. 44.
    Baron TH, Peterson BT, Mergener K et al (2006) Quality indicators for endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 101:892–897PubMedCrossRefGoogle Scholar
  45. 45.
    Andriulli A, Le Perfido S, Napolitano G et al (2007) Incidence Rates of Post-ERCP Complications: a systematic survey of prospective studies. Am J Gastroenterol 102:1–8CrossRefGoogle Scholar
  46. 46.
    Barthet M, Lesavre N, Desjeux A et al (2002) Complications of endoscopic sphincterotomy: results from a single tertiary referral center. Endoscopy 34:991–997PubMedCrossRefGoogle Scholar
  47. 47.
    Boender J, Nix GA, de Ridder MA et al (1994) Endoscopic papillotomy for common bile duct stones: factors influencing the complication rate. Endoscopy 26:209–216PubMedCrossRefGoogle Scholar
  48. 48.
    Chen YK, Foliente RL, Santoro MJ (1994) Endoscopic sphincterotomy-induced pancreatitis: increased risk associated with nondilated bile ducts and sphincter of Oddi dysfunction. Am J Gastroenterol 89:327–333PubMedGoogle Scholar
  49. 49.
    Choudari CP, Fogel E, Kalayci C et al (1999) Therapeutic biliary endoscopy. Endoscopy 31:80–87PubMedCrossRefGoogle Scholar
  50. 50.
    Christensen M, Matzen P, Schulze S, Rosenberg J (2004) Complications of ERCP: a prospective study. Gastrointest Endosc 60:721–731PubMedCrossRefGoogle Scholar
  51. 51.
    Christoforidis E, Goulimaris I, Kanellos I et al (2002). Post-ERCP pancreatitis and hyperamylasemia: patient-related and operative risk factors. Endoscopy 34:286–292PubMedCrossRefGoogle Scholar
  52. 52.
    Deans GT, Sedman P, Martin DF et al (1997) Are complications of endoscopic sphincterotomy age related? Gut 41:545–548PubMedCrossRefGoogle Scholar
  53. 53.
    Dickinson RJ, Davies S (1998) Post-ERCP pancreatitis and hyperamylasaemia: the role of operative and patient factors. Eur J Gastroenterol Hepatol 10:423–428. Erratum in: Eur J Gastroenterol Hepatol (1998) 10:731PubMedCrossRefGoogle Scholar
  54. 54.
    Freeman ML, Nelson DB, Sherman S et al (1996) Complications of endoscopic biliary sphincterotomy. N Engl J Med 335:909–918PubMedCrossRefGoogle Scholar
  55. 55.
    Köklü S, Parlak E, Yüksel O, Sahin B (2005) Endoscopic retrograde cholangiopancreatography in the elderly: a prospective and comparative study. Age Ageing 34:572–577PubMedCrossRefGoogle Scholar
  56. 56.
    Leese T, Neoptolemos JP, Carr-Locke DL (1985) Successes, failures, early complications and their management following endoscopic sphincterotomy: results in 394 consecutive patients from a single centre. Br J Surg 72:215–219PubMedCrossRefGoogle Scholar
  57. 57.
    Loperfido S, Angelini G, Benedetti G et al (1998) Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study. Gastrointest Endosc 48:1–10PubMedCrossRefGoogle Scholar
  58. 58.
    Lal D, Lane M, Wong P (2003) Complications of endoscopic retrograde cholangiopancreatography. N Z Med J 116(1177):U496PubMedGoogle Scholar
  59. 59.
    Masci E, Mariani A, Curioni S, Testoni PA (2003) Risk factors for pancreatitis following endoscopic retrograde cholangiopancreatography: a meta-analysis. Endoscopi 35:830–834CrossRefGoogle Scholar
  60. 60.
    Ong TZ, Khor JL, Selamat DS et al (2005) Complications of endoscopic retrograde cholangiography in the post-MRCP era: a tertiary center experience. World J Gastroenterol 11:5209–5212PubMedGoogle Scholar
  61. 61.
    Rabenstein T, Hahn EG (2002) Post-ERCP pancreatitis: is the endoscopist’s experience the major risk factor? JOP 3:177–187PubMedGoogle Scholar
  62. 62.
    Sherman S, Ruffolo TA, Hawes RH, Lehman GA (1991) Complications of endoscopic sphincterotomy. A prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts. Gastroenterology 101:1068–1075PubMedGoogle Scholar
  63. 63.
    Suissa A, Yassin K, Lavy A, Lachter J (2005) Outcome and early complications of ERCP: a prospective single center study. Hepatogastroenterology 52:352–355PubMedGoogle Scholar
  64. 64.
    Tanner AR (1996) ERCP: present practice in a single region, Suggested standards for monitoring performance. Eur J Gastroenterol Hepatol 8:145–148PubMedCrossRefGoogle Scholar
  65. 65.
    Tzovaras G, Shukla P, Kow L et al (2000) What are the risks of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography? Aus N Z J Surg 70:778–782CrossRefGoogle Scholar
  66. 66.
    Vandervoort J, Soetikno RM, Tham TC et al (2002) Risk factors for complications after performance of ERCP. Gastrointest Endosc 56:652–626PubMedCrossRefGoogle Scholar
  67. 67.
    Esber EJ, Sherman S (1996) The interface of endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Gastrointest endosc N Am 6:57–80Google Scholar
  68. 68.
    Chang WH, Chu CH, Wang TE et al (2005) Outcome of simple use of mechanical lithotripsy of difficult common bile duct stones. World J Gastroenterol 11:593–596PubMedGoogle Scholar
  69. 69.
    Roberts-Thomson IC (2004) The management of bile duct stones. Indian J Gastroenterol 23:102–106PubMedGoogle Scholar
  70. 70.
    Hui CK, Lai KC, Ng M et al (2003) Retained CBDS: a comparison between biliary stenting and complete clearance of stones by electrohydraulic lithotripsy. Aliment Pharmacol Ther 17:289–296PubMedCrossRefGoogle Scholar
  71. 71.
    Di Sario J, Chuttani R, Croffie J et al (2007) Biliary and pancreatic lithotripsy devices. Gastrointest Endosc 65:750–756CrossRefGoogle Scholar
  72. 72.
    Katsinelos P, Galanis I, Pilpilidis I et al (2003) The effect of indwelling endoprosthesis on stone size or fragmentation after long-term treatment with biliary stenting for large stones. Surg Endosc 17:1552–1555PubMedCrossRefGoogle Scholar
  73. 73.
    Schumacher B, Frieling T, Haussinger D et al (1998) Endoscopic treatment of symptomatic choledocholithiasis. Hepatogastroebterology 45:672–676Google Scholar
  74. 74.
    Chan AC, Ng EK, Chung SC et al (1998). CBDS become smaller after endoscopic biliary stenting. Endoscopy 30:356–359PubMedCrossRefGoogle Scholar
  75. 75.
    Bergman JJ, Rauws EA, Tijssen JG et al (1995) Biliary endoprostheses in elderly patients with endoscopically irretrievable CBDS: report on 117 patients. Gastrointest Endosc 42:195–201PubMedCrossRefGoogle Scholar
  76. 76.
    De Palma GD, Galloro G, Siciliano S et al (2001) Endoscopic stenting for definitive treatment of irretrievable common bile duct calculi. A long-term follow-up study of 49 patients. Hepatogastroenterology 48:56–58PubMedGoogle Scholar
  77. 77.
    Jain SK, Stein R, Bhuva M et al (2000) Pigtail stents: an alternative in the treatment of difficult bile duct stones. Gastrointest Endosc 52:490–493PubMedCrossRefGoogle Scholar
  78. 78.
    McSherry CK (1989) cholecystectomy: the gold standard. Am J Surg 158:174–178PubMedCrossRefGoogle Scholar
  79. 79.
    Pejovic T (2001) Residual choledocholithiasis in elective cholecystectomy and choledocholithotomy. Acta Chir Iugosl 48:37–39PubMedGoogle Scholar
  80. 80.
    Nathanson LK, O’Rourke NA, Martin IJ et al (2005) Postoperative ERCP versus laparoscopic choledochotomy for clearance of selected bile duct calculi: a randomized trial. Ann Surg 242:188–192PubMedCrossRefGoogle Scholar
  81. 81.
    Bratucu E, Straja D, Marincas M et al (2006) Late choledochal pathology after cholecystectomy for choledocholithiasis. Chirurgia (Bucur) 101:289–295Google Scholar
  82. 82.
    Jones SA (1978) The prevention and treatment of recurrent bile duct stones by transduodenal sphincteroplasty. World J Surg 2:473–485PubMedCrossRefGoogle Scholar
  83. 83.
    McSherry CK, Glenn F (1980) The incidence and causes of death following surgery for nonmalignant biliary tract disease. Ann Surg 191:271–275PubMedCrossRefGoogle Scholar
  84. 84.
    Allen B, Shapiro H, Way LW (1981) Management of recurrent and residual common duct stones. Am J Surg 142:41–47PubMedCrossRefGoogle Scholar
  85. 85.
    Choi TK, Wong J, Ong GB (1982) Choledochojejunostomy in the treatment of primary cholangitis. Surg Gynecol Obstet 155:43–45PubMedGoogle Scholar
  86. 86.
    Lygidakis NJ (1982) Infective complications after choledochotomy. Incidence after T-tube drainage of the common bile duct or after choledochoduodenostomy. J R Coll Surg Edinb 27:233–237PubMedGoogle Scholar
  87. 87.
    De Almeida AM, Cruz AG, Aldeia FJ (1984) Side-to-side choledochoduodenostomy in the management of choledocholithiasis and associated disease. Facts and fiction. Am J Surg 147:253–259PubMedCrossRefGoogle Scholar
  88. 88.
    Broughan TA, Sivak MV, Hermann RE (1985) The management of retained and recurrent bile duct stones. Surgery 98:746–751PubMedGoogle Scholar
  89. 89.
    Den Besten L, Berci G. (1986) The current status of biliary tract surgery: an international study of 107 consecutive patients. World J Surg 10:116–122CrossRefGoogle Scholar
  90. 90.
    Girard RM (2000) Stones in common bile duct: surgical approaches. In Blumgart LH, Fong Y (eds): Surgery of the liver and biliary tract, 3rd ed. Philadelphia, Saunders, p. 737Google Scholar
  91. 91.
    Srivengadesh G, Kate V, Ananthakrishnan N (2003) Evaluation of long-term results of choledochoduodenostomy for benign biliary obstruction. Trop Gastroenterol 24:205–207PubMedGoogle Scholar
  92. 92.
    Zhe-Fu Li, Xiao-Ping Chen (2007) Recurrent lithiasis after surgical treatment of elderly patients with choledocholithiasis. Hepatobiliary Pancreat Dis Int 6:67–71Google Scholar
  93. 93.
    Maeda A, Yokoi S, Kunou T et al (2003) Bile duct cancer developing 21 years after choledochoduodenostomy. Dig Surg 20:331–334PubMedCrossRefGoogle Scholar
  94. 94.
    Sellner FJ, Wimberger M, Jelinek R (1988) Factors affecting mortality in transduodenal sphincteroplasty Surg Gynecol Obstet 167:23–27PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Carmelo Sciumè
    • 1
  • Girolamo Geraci
    • 1
  • Franco Pisello
    • 1
  • Tiziana Facella
    • 1
  • Francesco Li Volsi
    • 1
  • Giuseppe Modica
    • 1
  1. 1.Department of SurgeryUniversity of PalermoPalermoItaly

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