ABSTRACT
The aim of this study was to evaluate a modified pathway of management of stones in the common bile duct. Twenty-five patients with gallstone disease were included in this study. All had clinical and/or chemical evidence of bile duct obstruction. For each patient, an abdominal ultrasound was done, followed by magnetic resonance cholangiography. The results were compared. Then, endoscopic retrograde cholangiography was performed, essentially for the removal of bile duct stones. Ultrasound revealed bile duct stones in 11 patients; while, in the rest of the patients, it was inconclusive. Magnetic resonance examination was normal in four patients [i.e. no obstruction found]; while it confirmed the presence of biliary obstruction in 21 patients; 17 due to stones and 2 due to other causes and in 2 patients, there was no obvious cause of obstruction. Endoscopic retrograde cholangiography was attempted in 23 patients. It was possible to insert endoscopic stents in two patients with malignant obstruction who needed no further surgery. The stones were endoscopically removed in 18 patients. Laparoscopic cholecystectomy was successfully performed in 20 patients. Open cholecystectomy and bile duct exploration were done in three patients