Several nonsurgical methods of therapy are available for treatment of retained common bile duct calculi. These include percutaneous extraction, endoscopic extraction, dissolution, and endoscopic sphincterotomy. The method chosen depends on location and size of calculi, size of sinus tract, patient age, surgical risks, and other factors. In most cases, procedures can be carried out safely and successfully with few or no complications.

Multiple techniques are now available for management of the patient with retained or recurrent common bile duct calculi. The goal of treatment is extraction of calculi with the lowest possible incidence of morbidity and mortality, the lowest cost and least discomfort to the patient, and the best long-term results. The choice of therapy--surgical or nonsurgical--depends on several factors, including presence or absence of the gallbladder and a T tube, type of calculi, operative risk, accompanying conditions, and expertise available at a particular institution. The decision to explore the common bile duct at the time of elective cholecystectomy is based on clinical, operative, and cholangiographic information. A rigorous technique of surgical exploration that includes duodenal mobilization, choledochoscopy, and cholangiography is necessary. In selected patients, biliary enteric anastomosis decreases the incidence of retained or recurrent calculi.