Common bile duct lithiasis: therapeutic approach

Abstract

INTRODUCTION: Treatment of cholecysto-choledocholithiasis has been revisited from the standpoint of either endoscopic or laparoscopic mini invasive approach. A standard diagnostic-therapeutic procedure has not been unanimously defined.

PATIENTS AND METHODS: Since 1997 to 2011 we have treated 924 patients: 555 gallbladder lithiasis, 276 acute biliary pancreatitis and 93 choledocholithiasis (without pancreatitis). We have compared, by the review of the literature, our results of two stage endoscopic stones removal followed by laparoscopic cholecystectomy versus one stage laparo-endoscopic rendez vous technique/VLC and laparoscopic approach alone.

RESULTS: In our experience endoscopic removal of stones have been performed in 82 patients (88.17%); 11 patients (11.82%),not elegible for endoscopic approach, have been submitted to laparotomic therapy. In sum preoperative ERCP/ES with CBD cleaning followed by VLC, not with standing the valid results of laparoscopic approach alone remains the strategy more frequently applied in clinical practice, because the good results.

CONCLUSIONS: The results of the treatment of CBD lithiasis of sequential laparo-endoscopic approach (two or one stage) and of laparoscopic approach alone are roughly overlappable. Therefore the first has remained the treatment of reference and comparison in all the clinical evaluation of different procedure.