[The therapeutic strategy in calculosis of the main biliary tract]

With the advent of laparoscopic techniques and other nonoperative techniques, the management of patients with common bile duct (CBD) stones became more complex. With low, medium or high preoperative suspicion of CBD stones, three factors influence the correct management: the degree of endoscopic, radiologic and laparoscopic expertise; the severity of symptoms; the presence or absence of the gallbladder. In patients with a low probability of having CBD stones routine ERCP pre-LC appears inappropriate. The management of patients with medium probability of CBD stones depends on the ability of the laparoscopist to remove CBD stones. A single laparoscopic procedure for cholelithiasis and CBD stones would be the best approach in the majority of patients. ERCP should be considered the procedure of choice in patients with severe gallstones pancreatitis, acute cholangitis and in those with a high probability of having CBS stones.