Complex Bile Duct Stones

Stones are most commonly found in the gall bladder and maybe present in a lot of normal people. If they are asymptomatic the patient does not need any surgical intervention. If the patient is symptomatic and has had episodes of biliary colic then these are dealt with a cholecystectomy operation (removal of the gall bladder). Occasionally the problem is complicated with migration of these stones in to the bile duct as seen in the adjoining pictures.

At the Liver and Pancreas Center we have a multidisciplinary team approach to this problem. If the stones are diagnosed prior to an operation then these can be cleared out by our gastroenterology colleagues. They usually put a scope in and perform a specialized procedure called an ERCP. During this process they can push a small basket in and grasp the stone and remove it.

However there are limitations to this procedure depending on the size of the stone and location of the stones. If they cannot be retrieved endoscopically then these must be removed at the time of surgery. Often some of these can be cleared laparoscopically, but if not possible, then a formal open operation may be necessary. Most general surgeons are comfortable removing non-impacted stones. However, sometimes these can be complex problems for the non-specialized HPB (hepato-pancreato-biliary) surgeon. Surgeons who are specialized in HPB surgery obtain better results in the treatment of this problem. A multidisciplinary approach, i.e. a collaboration of surgeons, interventional radiologists, and interventional gastroenterologists is essential to a successful outcome. At the Liver and Pancreas Center, we provide comprehensive evaluation and all around care for these complex stones and take great pride in being able to provide the highest level of care for these complex problems.