Retained and recurrent bile duct stones: operative management.

Retained and recurrent bile duct stones can now be treated by a variety of nonoperative means. These include retrieval through instrumentation of the T-tube tract, chemical dissolution, endoscopic papillotomy, or lithotripsy. Operative management, however, is an alternative means of therapy that carries negligible mortality, minimal morbidity, and a high success rate. If operative management is used, for most patients common duct exploration, stone retrieval, and T-tube insertion will suffice. However, if the patient has risk factors that suggest the possibility of further stone disease, a drainage procedure such as a sphincteroplasty or choledochoduodenostomy should be added. Nonoperative management is now the first choice for managing retained or recurrent bile duct stones. If these methods fail or cannot be utilized, operative management can be used with a similar low mortality, low morbidity, and high success rate.