[Integration of operative endoscopy and laparoscopic surgery in the treatment of cholecysto-choledocholithiasis].

Laparoscopic cholecystectomy has become first choice for symptomatic gallstones, but there are not agreement about therapy of supposed synchronous choledocholithiasis. We report our experience about the sequential treatment (endoscopic-laparoscopic) of the gallstone and the associated common bile duct stones.

METHODS

During the period Jan. 1992 Dec. 1997 we have evaluated 128 patients that were submitted to ERCP for suspicion CBDS and gallstone. All patients undertook a systematic assessment: Patient age, sex, history of jaundice, history of pancreatitis, levels of serum alanine aminotransferase, alkaline phosphatase, amylase, total and direct bilirubin and CBD diameter on ultrasonography.

RESULTS

In the 96 (75%) cases of choledocholithiasis endoscopic sphincterotomy has been performed and combined with laparoscopic cholecystectomy. Thirty-two patients (25%) submitted to ERCP have been negative for stones. Only 4 patients have needed surgery because of big stones inside the CBD after ESWL failure. The incidence of complications of ERCP-ES has been, in our experience, 7.1% and mortality 0.8%. All the complications have been treated conservatively and did not need surgery.

CONCLUSIONS

The sequential treatment (endoscopic-laparoscopic) of synchronous CBDS and gallstone, in hands of expertise, is efficient with high rate of success and low rate of complications in order to morbidity and mortality. Finally we believe that it is very important to discover CBDS preoperatively with the non invasive methods as the MRI-Colangiography and to assay the liver tests in order to avoid negative ERCP for choledocholithiasis.