Repeat stones post Cholecystectomy

I have just had an ERCP following acute pain and stones found on ultrasound in the bile duct. My gall bladder was removed laprossopically 12 years ago aged 26. What is the incidence of this? How likely is it to happen again? Is there anything I can do to avoid further stone production? The pain was immense until the stones were removed and I am scared of undergoing this awful ordeal again in the future.
No one seems clear why this has happened for a second time. I am now 38, a physical therapist, slim and very fit. My diet is healthy and I weigh 65kg at height 5'6''. I would be grateful on any view point or references I can follow.

[CalGal]

There are two methods that I know of by which people seem to 'develop' stones after GB surgery - even many years afterward. One is that some small stones escape during the surgery  and however they're able to do so, they manage to lodge themselves in areas of the common bile duct until something disturbs them and they begin causing trouble.

The other theory is that due to changes in the structure of the common bile duct following GB surgery in some, small pockets or outpocketings forms and the flow of bile over or through these 'formations' cause eddying - and eddying result in the depositing of small 'nuclei' that starts the formation of a stone. It's analogous to the eddying that occurs in blood vessels that purportedly caused obstructions in the circulatory system.

I'm not sure if anyone knows how to prevent this from happening, I'm sorry to say. But if the formation is due to deposition of cholesterol (do you know if the stones were cholesterol based?), supposedly if your cholesterol levels remain low and you remain well-hydrated, cholesterol may not be able to precipitate as quickly or as well out of solution.

You might also want to ask your doc about possibly using a medication such as Actigall. It may or may not be a preventative measure, but check with your doc.

[Jaybay]

One other issue is the changing hormones we ladies experience in perimenopause.  Hormone levels have a big impact on how thick the bile is that is produced in the liver.  The thicker the bile, the greater the likelihood that it will form into sludge/ stones.  That is one reason that the "classic" gallbladder patient is Female, Fertile and Forty.  It's not all that uncommon for a woman to develop gallstones during pregancy - particularly nowadays with older women having babies.  

Diet isn't always the culprit in stone formation.  It's more about how each person's body produces bile.  Some people have had good results using statin drugs like questran to keep the bile thinned out and moving properly through the ducts.  You're doing everything right as far as diet and fitness, and it's probably unlikely that you would have to go through this again.  Definitely ask your doctor about actigall or questran as a preventive measure.  The side effects of these meds may not be worth taking them, but the subject is certainly worthy of a discussion with your doctor.