Evolving management of biliary tract disease.

The variety of treatments available for gallstone-related problems require a multidisciplinary approach with involvement of the surgeon, endoscopist, and radiologist. Many conditions, until recently treatable only by an open operation, can now be satisfactorily dealt with by minimally invasive or endoscopic techniques. The benefits of such techniques are immediately apparent in terms of reduced hospital stay and early patient recovery. The pace of progress, particularly in the area of laparoscopic biliary surgery, is rapid and has important implications for surgical training and resources. Careful audit and prospective trials, when appropriate, are required to determine optimum treatment strategies for patients with benign biliary disease. These are exciting times in surgery, but our enthusiasm for new techniques should not cloud time-honored surgical principles.