The prevalence of common bile duct stones increases with age. Whereas patients under 60 show a prevalence of 8-15%, the rate increases up to 15-60% > 60 years. The main goal of optimal preoperative diagnosis and treatment of bile duct stones is to avoid unnecessary and negative investigations and to decrease the rate of retained/missed stones. Anamnestic and clinical pointers, laboratory findings and "simple" radiological examinations (ultrasonography, intravenous cholangiography) allow selective preoperative ERCP. The reported clearance rates for ERCP are as high as 95%, with a morbidity and mortality of 3-15% and 0.2-2.5% respectively. Only after endoscopic stone removal should laparoscopic cholecystectomy be added. Laparoscopic bile duct exploration is technically demanding and offers no objective advantages compared to ERCP.