Management of recurrent and residual common duct stones

When operating on patients with postcholecystectomy choledocholithiasis, a drainage procedure should be performed for the following indications: (1) multiple stones in the duct, (2) history of choledocholithotomy, (3) marked dilatation of the duct, (4) inability to remove all stones, and (5) presence of a ductal stricture. Patients with none of these are adequately treated by choledocholithotomy alone. Because endoscopic sphincterotomy has been shown to be safe and effective, however, it is currently our preferred method of treatment for the average patient with this condition.