A history of the dissolution of retained choledocholithiasis

BACKGROUND: Common duct calculi retained after gallbladder surgery continue to present a clinical challenge especially in the era of minimally invasiv e surgery. This review examines the strategy of dissolution therapy used th roughout the history of biliary tract surgery and its use to the modern sur geon. DATA SOURCES: Original journal articles and reviews were identified using s tandard surgical textbooks and MEDLINE. Keywords for searching included cho ledocholithiasis, dissolution, mono-octanoin, common duct stones, MTBE, cho lic acid, and gallstones. CONCLUSIONS: Dissolution therapy used initially as an alternative to open s urgery is now used more effectively as an adjunct to laparoscopic or endosc opic biliary tract surgery. The current review demonstrates a majority of p atients with retained choledocholithiasis respond to dissolution and can be safely managed without choledochotomy. Am J Surg. 2000;180:86-98. (C) 2000 by Excerpta Medica, Inc.