Incidence and significance of primary stones of the common bile duct in choledocholithiasis.

To assess the significance of primary common bile duct stones as an index predisposing to recurrent choledocholithiasis, 522 patients who underwent choledochotomy are presented in this study for further discussion. There was an association of primary common bile duct stones with bile infection, with an increased incidence of anaerobes in bile cultures and with an advanced inflammatory infiltration of the biliary tree. Furthermore, primary common bile duct stones have an increased incidence in patients with a long history of symptoms of the disease, of advanced age and who have had previous biliary surgical treatment. Primary stones are an index of existent biliary stasis and have to be taken into serious consideration in dealing with patients suffering from biliary lithiasis.