[Common bile duct lithiasis. Analysis of surgical treatment of 130 consecutive cases]

Common bile duct lithiasis can be treated either surgically or endoscopically. Generally, morbidity and mortality is thought to be greater for surgery. The aim of this work was to evaluate the results of surgical cure in 130 consecutive patients treated from 1983 to 1993.

Transcytic extraction was performed in 16 cases, ideal choledocotomy in 25, choledocotomy with external biliary drainage in 45, choledocojuodenal anastomosis in 14 and transduodenal sphincterotomy in 32.

There were 3 deaths. Morbidity was 11.5%. The postoperative hospitalization time was 9.86 +/- 8.9 days for patients without drainage and 15.13 +/- 3.09 days with drainage. Stone extraction was unsuccessful in 2 cases.

Morbidity and mortality for surgical cure of common duct lithiasis are comparable or lower than for endoscopic sphincterotomy. It is much more adapted for stone desobstruction via the choledoscopy. Supra-duodenal choledocotomy without external drainage was performed in most cases with a small incision and without touching the Oddi sphincter thus allowing a hospital stay equivalent to that for endoscopic sphincterotomy. Associating surgery with laparoscopic cholecystectomy would allow simple benign treatment in most cases of common bile duct lithiasis.