Differentiate primary from secondary common bile duct stones.

Primary common bile duct stones are those that form within the intra- or extra-hepatic bile ducts,
excluding the gallbladder. These stones are formed mainly due to bile stasis or an infection in the
common bile duct. They are usually formed after cholecystectomy associated with
sphincterotomy or another surgical procedure that alters or bypasses the sphincter of Oddi,
which facilitates the passage of bacteria from the duodenum into the bile tract, and they often
develop as recurrent common duct stones. 99% of primary bile duct stones are pigment type.

Meanwhile, secondary common bile duct stones are formed in the gallbladder that migrated into
the bile duct. These stones represent 95% of common bile duct stones. They are identical in
composition to gallbladder stones and their sizes are limited by the diameter of the cystic duct,
hence, making them smaller than primary common bile duct stones.