General and Gastrointestinal Surgery

Common Duct Stones

Most patients who have common duct stones have abnormalities that suggest they are present preoperatively.  These signs and symptoms include: 

  • yellow eyes or skin (jaundice or icterus),
  • tea-colored urine
  • clay-colored stools
  • abnormal liver function

If none of these findings are present, the likelihood of having common duct stones is less than 5%.  If there is a high suspicion of common duct stones preoperatively you will be asked to undergo a test called an endoscopic retrograde cholangiopancreatography (ERCP).

About ERCP

ERCP is an outpatient endoscopic procedure in which a small tube is passed down the throat into the duodenum, the part of the intestine after the stomach. The patient is given heavy intravenous sedation for this procedure.  This tube is actually a scope which allows the doctor to see the end of the common bile duct as it empties into the duodenum.  The doctor can inject dye into the duct via this scope and see if stones are present in the duct.  If they are, he or she will make a small incision in the duct and pull out the stones.  This will then be followed by a laparoscopic cholecystectomy.

During laparoscopic cholecystectomy an x-ray may be performed during the operation to determine if there are stones present in the main bile duct.  Although some surgeons do this x-ray routinely, we have found it to be unnecessary in most patients.  Thus, we use certain criteria to determine the need for cholangiography.  These criteria are those associated with a high possibility of common duct stones.  If stones are present on this x-ray, the laparoscopic cholecystectomy will be completed and the patient will undergo ERCP to remove the stones within the next few days.  Alternatively, we may choose to remove them in the operating room by a procedure called a common duct exploration. Patients often stay in the hospital overnight if that procedure is performed.

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