[Therapeutic development in common bile duct lithiasis. Apropos of a 25-year experience]

Authors' experience in the treatment of common bile duct stones (LVBP), including 592, operated patients, is presented. During the years 1969-1983, the most used technique was transduodenal sphincterotomy, while after 1983 choledocotomy, mostly with associated external temporary biliary drainage, was the preferred one. Since 1985 endoscopic sphincterotomy (SE) has been used, firstly for high-risk patients, and then with increasing indications; at present the first choice in treatment of LVBP consists in sequential SE and laparoscopic cholecystectomy. Postoperative results of these techniques showed a specific mortality rate of 1.1% for ST, of 0% for CT and SE, and a specific morbidity rate of 4.6% for ST, of 6.9% for CT and of 5.6% for SE. At follow-up patients in I and II Visick group were 87% for ST, 91% for CT and 100% for SE. Even if a statistical analysis of such results is not proposable, the only existence of a specific mortality for ST made us to change our choice. At present the treatment of choice for LVBP is in our opinion the sequential SE and laparoscopic cholecystectomy, waiting for a complete evaluation of all laparoscopic procedure. Traditional surgery is now indicated for failures of sequential approach and, as a first choice, for treatment of "empierrement" of common bile duct, for intrahepatic lithiasis and for atonic megacholedocus.