Choledocholithiasis: new approach to an old problem

The old problem of diagnosis and treatment of choledocholithiasis is analyzed in light of recent developments in the field of radiology and surgery. The traditional indications for common bile duct (CBD) exploration resulted in a large number of unnecessary manipulations of the bile ducts. The same is now true of the widespread use of endoscopic retrograde cholangiopancreatography. With the advent of magnetic resonance imaging cholangiography, which can clearly demonstrate CBD calculi by means of a noninvasive, complication-free technology, we should abandon the old indications for CBD exploration and be more conservative regarding the diagnosis and management of this condition. In an era of minimally invasive surgery we are seeing a significant reduction in the number of patients with choledocholithiasis.