Surgery and interventional techniques in bile duct diseases. Combination procedures or another mode?

Bile duct stones, benign lesions of the bile duct, and malignant stenoses a re principal entities requiring an interdisciplinary approach to diagnosis and treatment. There are unequivocal indications for surgical and intervent ional approaches. In many situations sparse data do not allow for clear-cut recommendations, which leads to a competition of surgical and intervention al mo des of treatment. In cholecystocholedocholithiasis, therapeutic split ting - endoscopic stone extraction and laparoscopic cholecystectomy - is at present the preferred strategy. The laparoscopic approach, including commo n bile duct exploration, may prove advantageous in the future. Emergency si tuations caused by choledocholithiasis - purulent cholangitis and biliary p ancreatitis - require interventional treatment. For bile duct injuries with biliary leakage and treatment of short strictures, transpapillary or trans hepatic prostheses may be adequate. In extended strictures or bile duct def ects, surgical repair is required. In malignant stenoses, surgical treatmen t provides the longest survival. If operability is excluded, an interventio nal approach offers substantial palliation. The results of the different fo rms of stents and prostheses are comparable.