Overview Hepatolithiasis (intrahepatic stones) is defined as the presence of gallstones in the bile ducts peripheral to the confluence of the right and left hepatic ducts. These intrahepatic stones can simultaneously be present with stones in the common bile duct…
Diagnostic considerations Imaging modalities: Why and when Determining the presence of cholecystolithiasis and choledocholithiasis can be challenging and often relies on indirect evidence of obstruction. For choledocholithiasis, clinicians use predictive models based on risk factors that include clinical features, abnormal…
Historical overview In the 1970s and 1980s, endoscopic retrograde cholangiopancreatography (ERCP) transformed the diagnostic approach to suspected biliary disease and jaundice (see Chapters 20 and 30 ). Similarly, in the years since it was first performed in humans, , endoscopic…
Introduction Epidemiology of choledocholithiasis The prevalence of cholelithiasis is approximately 15% in the general population, with up to 10% of patients having concomitant choledocholithiasis (CDL; for more information, see Chapter 33 ). The prevalence of gallstones is increased in the…
Overview The first successful common bile duct exploration (CBDE) by Thornton in 1889 and the introduction of catheter-based biliary decompression by Courvoisier and Kehr marked the initial efforts in treating choledocholithiasis. Open cholecystectomy and bile duct exploration were performed commonly…
Overview Cholecystectomy is one of the most frequently performed general surgery procedures in the United States (US) with over 500,000 being performed annually. There are many reasons for this, including the frequency of gallbladder disease and indications for intervention in…
Overview The first reports of an operative cholecystostomy are attributable to Johannes Fabricius (1618) and Stalpert Von Der Wiel (1667) who described the procedure as occurring almost by happenstance upon the incision of an abdominal wall abcess. The following two…
Overview Cholecystitis, a common condition usually resulting from complications of cholelithiasis, occurs in two forms: acute and chronic. Acute cholecystitis requires urgent intervention, typically with antibiotics and cholecystectomy. In the setting of acute cholecystitis, cholecystectomy is optimally performed within 72…
Introduction The aim of this chapter is to describe established and novel findings on the natural history of gallstones. Gallstones have been a scourge of humankind for millennia. Each year surgeons perform over 700,000 cholecystectomies in the United States alone,…
Overview Minimally invasive techniques to manage biliary pathology have reduced the need for open operative intervention. Although open exploration for biliary disease has become less common, specific situations like obstructive common duct stones not amenable to endoscopic therapy or restoration…