Management of bile duct stones

The management of stones in the bile duct has changed significantly since the introduction of minimal access surgery. For stones which present at the time of laparoscopic cholecystectomy, techniques via the cystic duct allow for the removal of most stones. Choledoscopy performed laparoscopically is often unnecessary, but may be performed if the duct is of appropriate size. In most other patients an endoscopic approach. either peroperatively or postoperatively, will deal with any remaining stones. In patients presenting following cholecystectomy, the endoscopic approach is the optimal technique for treatment of bile duct stones.