Primary common bile duct stones

Abstract

Primary or stasis stones in the common duct are a distinct clinical, anatomical, and pathological entity. In the older patient with chills, fever, and jaundice, it is axiomatic that a primary or stasis stone will be found in a common duct that measures 20 mm or more in diameter. Furthermore, about 20% of such patients will not have stones in the gallbladder. The symptom of chills, having not been observed in patients with cancer of the head of the pancreas, is considered a diagnostic aid in the differentiation of jaundice secondary to common duct stones from jaundice due to malignant obstruction. The primary or stasis stone is the most common type of common duct stone. When present, a definitive operation, preferably choledochoduodenostomy, is advised. A simplified classification of biliary tract stones, preferably that of Aschoff, should be established as the universal standard. Also, based on this standard, worldwide prospective clinical studies should be initiated to obtain data for comparative evaluations to determine the true incidence of primary common duct stones.

Laparoscopic choledochoduodenostomy

“…The mean ASA score was 1.6 (1-3). The median operation time was 137.5 min (90-270) and median postoperative stay was 7.5 days (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The median diameter of CBD was 20 mm (15-33), and all of them had multiple muddy stones inside the main CBD.…”

“…On average, they underwent four sessions (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) of ERCP prior to the LCD. The mean ASA score was 1.6 (1-3).…”

“…Yet there has been some controversy in performing this drainage operation because of fear of ascending cholangitis and sump syndrome. However, the excellent results achieved by Madden, Sanders, and Hurwitz have made CD an acceptable option in benign stone diseases [8,11,18]. Franklin et al performed the first successful LCD in 1991, and this was followed by several case series with some modifications.…”

Primary “Brown Pigment” Bile Duct Stones

“…However, Madden (1978) 9 has suggested that such patient related criteria may limit the occasions in which PBDS can be identified. Hence, following extensive studies into PBDS structure, Madden (1968,1973) 78 has suggested that PBDS could be accurately identified by morphologic features alone.…”

Follow-up studies of surgical treatment for choledocholithiasis.

“…In order to permit residual stones to flow away into the intenstinal canal and/or to eliminate bile stasis, transduodenal sphincteroplasty (Stefanini et al 1974;Jones 1978) and bilioenteric anastomosis (Johnson and Rains 1978;Mudden 1978) are frequently applied as the drainage procedures in the surgical treatment of choledocholithiasis. However, indications of these additional procedures are controversial.…”