Biliary lithiasis: retrospective analysis of a case series

The paper analyses a series of biliary lithiasis cases encountered in 1983-92 in which cholelithiasis accounted for 79.3%, cholecystocholedochic calculosis for 16.6%, chronic stenotic papillitis for 2.1%, residual/recurring calculosis of the main biliary way after cholecystectomy for 1.7% and intrahepatic calculosis for 0.3%. Among the cases involving the main biliary way, the highest percentage (35/50 cases or 70%) of transduodenal papillosphincterostomies was performed in the first five years, while endoscopic papillosphincterotomy prevailed (28/42 or 66.7%) in the second five years. The endoscopic technique was initially considered elective for residual/recurring biliary calculosis after cholecystectomy and for cholecystocholedochic calculosis in patients who were elderly and/or at risk. Thereafter its use was gradually extended as technological developments allowed its use as a complementary technique in cases of giant stones. The advent of minimally invasive surgery has given a further boost to the use of endoscopic clean-up procedures in cases of biliary calculosis prior to laparoscopic cholecystectomy. The laparoscopic treatment of gallstones is a more recent development.