[Treatment of bile duct stones by laparoscopy, endoscopy or combined approaches]

Gallstones are a very common disease in our area, with a prevalence of 21.9%. Among the most common complications, choledocholithiasis is associated in about 3% to 10% of cases. The treatment may be performed by minimally invasive laparoscopy, endoscopy or a combination of both. There is no current consensus on what is the best strategy for treatment. We aimed to review the evidences of highest quality available, comparing two therapeutic strategies for cholelithiasis. Choledocholithiasis is divided into that in patients who underwent a cholecystectomy and that in patients with associated cholelithiasis. In the first group we have three subgroups: a) patients in whom gallstones remained intraoperatively, b) patients with bile duct lithiasis and biliary drainage, and c) patients with bile duct lithiasis without biliary drainage. In the first case can be performed a laparoscopic treatment at one or two times; in the second, a transfistular approach; and in the third, an endoscopic treatment. If the endscopic tretament fails, percutaneous or laparoscopic reoperation can be done. The treatment of a cholelithiasis associated with choledocholithiasis can be performed by laparoscopy, endoscopy or a combination of both. We conclude that the innovation of minimally invasive techniques has revolutionized the management of bile duct stones. The treatment in one time is possible in patients with adequate operative risk and in the hands of trained surgeons. Multidisciplinary approach is mandatory, according to the diagnostic and therapeutic method, depending on the means available in each institution.