For various reasons, the true incidence of biliary lithiasis is unknown. Since spontaneous internal biliary fistulae are a statistical function of cholelithiasis, their incidence is likewise unknown. One author estimates the incidence of such fistulae at 3%, based on a broad personal experience. The validity of this estimate is strongly questioned in the light of a recent paper from the Lahey Clinic,2 covering 29 years. Only 41 spontaneous internal biliary fistulae were treated in this period. This very low incidence is undoubtedly owing to more aggressive assault on the earlier phases of cholecystic disease in recent decades.
Of these 41 fistulae, 3 were cholecystocholedochal. The technique of establishing this diagnosis and the management thereafter were not touched upon. That a preoperative diagnosis will frequently be impossible is recognized.
From a practical standpoint, discussions with active surgeons with 15 and more years of experience have revealed the cholecystocholedochal fistula to