Cholelithiasis-Choledocholithiasis

The asymptomatic cholelithiasis usually not require surgery . Two or more episodes of biliary colic ( pain duration of 4-12 hours ) by affecting LFTs , stones < 3 mm , or an episode of gallstone pancreatitis , obstructive jaundice <2 mg / dl with spontaneous remission should be managed by  laparoscopic surgical intervention ie cholecystectomy . Also jaundice > 4mg/dl needs of ERCP by an experienced gastrenterologist. In case of failed ERCP, the presence of previous gastrectomy Billroth II, or impacted large common bile duct stone (with absence of endoscopic lithotripter ) , indicate the surgical performance of choledochojejunal or rarely choledochoduodenal anastomosis .