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Choledochal cysts are rare congenital dilatations of the extrahepatic bile ducts which may also involve the intrahepatic biliary system. According to the author’s material of 21 cases over a ten-year period (1991–2000), choledochal cysts come second to biliary atresia in frequency with a female to male ratio 4:1, and consitute the majority of cholestatic jaundice cases in childhood. The incidence in western countries is estimated between 1 in 100,000–150,000. In eastern countries the incidence of choledochal cysts is higher [ 1 , 2 ]

Most epidemiological studies, aimed at estimating gallstone prevalence and incidence rates, do not represent the general population. Until recently, data were mainly derived from autopsy studies (which were often subject to selection bias) and cholecystectomy rates (which fluctuate as much as fivefold between, different countries and periods of time) [ 1 ]. At present, accurate data from sonographic screening studies regarding prevalence of cholelithiasis, are available for Western Europe and US. The median prevalence ranges from 5.9% (Chianciano, Italy) to 21.9% (Bergen, Norway) in European studies [ 2 ]. In US, the NHANES III study [ 3 ] indicated an age standardised prevalence of gallstones higher among Mexican Americans (8.9% and 26.7% in males and females respectively)

The operative removal of the gallbladder is a standard and one of the most often performed procedures in general and visceral surgical hospital departments. The operation is indicated in cases of gallbladder stones creating disease symptoms and pain, in cases of acute infection of the gallbladder with or without stones and in cases of adenomatous structures in the gallbladder that may develop malignity [ 1 , 2 ]

The majority of biliary tract injuries are iatrogenic. They are usually associated with operations in the upper abdomen. More than 80% occur during cholecystectomy, one of the most common intra-abdominal operations. Langenbuch performed the first successful cholecystectomy in 1882, and since then the number of cholecystectomies has increased rapidly, inevitably increasing the number of complications. Iatrogenic bile duct injuries are unfortunately not rare and may have disastrous consequences and very significant long-term morbidity and mortality [ 1 ], [ 2 ]. With adherence to well-established technical principles for open cholecystectomy, the incidence of bile duct injuries remained at less than 0.5% in most of the published retrospective series [ 3 ], [ 4 ]

Choledocholithiasis has always been a challenge for surgeons dealing with biliary pathology. Both diagnosis and treatment have evolved over the last years with the introduction and universal application of advanced imaging modalities as well as endoscopic and laparoscopic procedures. Consequently, the management of choledocholithiasis has been the subject of debate for several years and the classic treatment option for the management of the common bile duct stones (CBD), which traditionally was the open exploration of the CBD, is progressively less favorable as a first approach

Choledocholithiasis is predictable in 8 and 15% of patients undergoing laparoscopic cholecystectomy, the percentage increasing with age. After the advent of laparoscopic cholecystectomy, endoscopic retrograde cholangio-sphincterotomy (ERCS) had essentially replaced open surgery for safe and effective common bile duct stone extraction, despite its significant morbidity and mortality. The performance of laparoscopic cholecystectomy and laparoscopic intraoperative cholangiography combined with technological advances in equipment and instruments made laparoscopic common bile duct exploration the next logical sequential step in cases of choledocholithiasis

The management of patients with common bile duct stones was always challenging and the introduction of endoscopic retrograde cholangiopancreatography (ERCP), three decades ago, had a major influence in the overall treatment. The profound advantages of ERCP vs open or laparoscopic surgery, established it as the predominant method for the treatment of choledocholithiasis. Endoscopic sphincterotomy of the main duodenal papilla, in combination with a number of older and innovative techniques for stone fragmentation and extraction, is nowadays considered the cornerstone of the endoscopic treatment for patients with common bile duct stones. Recent advances in radiologic imaging, such as magnetic resonance cholangiopancreatography (MRCP) and laparoscopic surgery are struggling to compete with ERCP, however ERCP continues to be a first line method in treating choledocholithiasis

Over the last decades and up-to-the present time, surgical reapproach to the biliary tree for benign lesions remain one of the main topics in surgery. Reoperations are necessary for: a. retained or recurrent stones in the biliary tree, b. stenosis at the level of sphincter of Oddi, c. malfunctioning previous bilio-digestive anastomoses, d. strictures and stenoses of the biliary tree — an entity which represents the most interesting point of biliary reoperations, e. intrahepatic lithiasis, cystic duct syndrome etc

Mirizzi’s syndrome is a rare entity that causes extrahepatic biliary strictures and occasionally an apparent tumor at the liver hilum associated with cholelithiasis, a condition that occurs in no more than 0.5% of cholecystectomies [ 1 ]. An impacted calculus in the gallbladder ampulla or in the cystic duct may cause direct pressure or edema (type I), or sporadically may erode through the wall of the cystic duct and into the common hepatic duct (type II) resulting in a colecystocholedochal fistula and causing in this way the obstruction of the common hepatic duct [ 2 ]. A cystic duct remnant calculus causing Mirizzi’s syndrome is exceedingly rare [ 3 ]

Cholangitis is an infection of the biliary ductal system. It is a result of bacterial infection superimposed on partial or complete obstruction of the biliary system. The original description of cholangitis, by Charcot in 1877 [ 1 ], alluded to inflammation and the symptoms now known as “Charcot’s triad” (intermittent chills and fever, jaundice and abdominal pain). In clinical practice, the term “cholangitis” is used to refer to the signs and symptoms produced by bacterial inflammation of the biliary duct system, without regard to the presence or absence of inflammatory changes within the walls of the bile ducts or the parenchyma of the liver. Bacteria can be present within the biliary tract (bacterbilia) without clinical symptoms and the bile of asymptomatic patients can harbor many bacteria if the biliary tree is otherwise normal. Thus, bacteria in bile, increased biliary pressure, and invasion of bacteria into the bile ducts and liver tissue are all important in the development of cholangitis