[Celioscopic treatment of choledocholithiasis: strategic problems. A clinical case]

The authors report a case of suspected calculosis of the common bile duct (CBD) associated with cholecystolithiasis, both of which were treated using a coelioscopic approach. Using a flexible Olympus 5 mm urethroscope and Schuller-type urethral dilator sound, it was possible to explore the choledochus visually using a transcystic route prior to dilating the latter gradually and attempting to extract calculi using Dormia's probe. In selected cases of calculosis of the common bile duct, with a dilated cystic duct, it is possible to explore the choledochus using a transcystic route but it is not yet possible to extract stones at the same time. If, on the other hand, the choledochus is further dilated, it is preferable and more satisfactory to perform a choledochotomy using a coelioscopic route. In the light of coelioscopic progress and its diagnostic and therapeutic possibilities, the authors report their criteria for suspected lithiasis of the common bile duct and attribute a precise and important role to echo-endoscopy since its results lead to a different therapeutic strategy.