[How great is the risk in surgical treatment of choledocholithiasis?]

With a success-rate of approximately 95 percent non-operative removal of bile duct stones following endoscopic sphincterotomy is a valuable alternative to operative treatment. If the gallbladder has not been removed previously an acute cholecystitis may develop in up to 20 percent of the patients. Approximately 50 percent of complications following non-operative treatment require emergency surgery. The most serious complications following operative treatment are retained bile duct calculi (2.8%), wound infection and biliary fistulae. In our experience with 499 patients postoperative morbidity was 16.0% and mortality 3.8%. Cause of death was related to surgical bile duct exploration in only two patients (0.4%). Operative treatment of bile duct stones remains the treatment of choice. Endoscopic intervention is a valuable alternative for the removal of retained stones or in frail patients not fit for general anaesthesia.