[The laparoscopic treatment of common bile duct lithiasis]

Recently the indications to video laparoscopic approach in abdominal surgery are considerably increased thanks to the very good results of the video laparocholecystectomy technique. The improvement of this methodology and of the instruments employed has permitted to extend the indications also to the treatment of cholecysto-choledochal lithiasis. After considering the actual possibilities of treating this kind of pathology, authors report their experience of 28 cases of choledocholithotomies carried out laparoscopically "at the same time" from October 1991 to October 1993, out of 431 operations on biliary tract performed for benign disease, 350 of which (81.2%) treated with a laparoscopic approach. In 26 cases the treatment has been completed. In one case (3.5%) it was necessary to perform a laparotomy due to an empyema with a wedged choledochal stone, in another case it was necessary to performed a laparoscopic-endoscopic treatment for removing wedged choledochal stone, but because of the failure of this treatment, a laparotomy followed. The only complication worth mentioning out of 27 choledocholithotomies performed is an external biliary fistula (3.7%) treated with a following laparotomy operation. The 25 patients only laparoscopically treated were discharged on the postoperative day 5. Even if a long-term follow-up lacks, authors consider the laparoscopic choledocholithotomy an efficacious cure for the treatment of cholecysto-choledochal lithiasis as it is a mini-invasive technique, which clears up the disease in one time, avoids not necessary papillotomy and reduces the risk of mortality and morbidity to their lowest terms.