The biliary tree is divided into intrahepatic and extrahepatic systems.
Extrahepatic bile ducts: gallbladder, common bile duct (CBD), common hepatic duct.
Intrahepatic bile ducts: second-order and third-order segmental ducts.
Treatment is chosen according to the exact location of the stone(s):
- Gallbladder stones – laparoscopic cholecystectomy.
- Common-bile-duct stones – laparoscopic CBD exploration with stone extraction.
- Intrahepatic stones complicated by cholangitis – often cause lobar atrophy; treat with hepatic lobectomy to remove the diseased parenchyma and relieve associated strictures.
- Diffuse intrahepatic stones (“full-liver” stones) – stricture-plasty or Roux-en-Y hepatico-jejunostomy is performed when extensive stricturing precludes simple clearance.
| Stone Location | Description | Primary Treatment |
|---|---|---|
| Gallbladder | Extrahepatic; stones within the gallbladder lumen | Laparoscopic cholecystectomy |
| Common bile duct (CBD) | Extrahepatic; stones distal to the cystic duct take-off | Laparoscopic CBD exploration + stone extraction |
| Intrahepatic + cholangitis | Segmental ducts (2nd/3rd order) with infection and lobar atrophy | Hepatic lobectomy (removes diseased lobe and stricture) |
| Diffuse intrahepatic (“full-liver” stones) | Multiple strictures & stones throughout intrahepatic ducts | Stricture-plasty or Roux-en-Y hepatico-jejunostomy |