[Cholelithiasis. Laparoscopic treatment with intracorporeal lithotripsy followed by cholecystostomy or cholecystectomy. Personal technique].

From November 1988 to February 1990 157 patients with gallbladder stones have been treated by a laparoscopic surgical procedure. They are 28 males and 129 females from 13 to 81 years old, 18 have had a cholecystostomy after intracorporeal lithotripsy (Lus Ultrasonic Olympus). They were placed on bile acids during 3 months. The average follow up time is 11 months. The mortality is zero and 2 mild complications occurred medically cured. 3 patients have a recurrent stone 6 month after surgery. 139 patients have had a cholecystectomy 89 after the same lithotripsy procedure seen above, 50 without prior lithotripsy. In 3 cases the laparoscopic procedure was abandoned, twice because of a sever bleeding, one for too compact surrounding adhesions. The mean follow up is 9 months. 123 were drained 1 day 16 had no drain. The mortality is zero. 2 patients without drainage developed a sub hepatic and douglas pouch abscess. They were cured by a lavage drainage laparoscopically made. 1 patient with drainage had a 7 days bile leak which disappeared spontaneously. The 136 others have had a short stay in the hospital (2-4 days) a painless post operative time. They could go back to work and sport within 1 week. They have minimal scars and no danger of incisional herniae. The magnification of the optical system enables the dissection of the cystic duct and artery easier and safer than it is by mini laparotomy mostly in obese people. At the beginning of our experience only the patients with frequent biliary colics have been selected for the laparoscopic procedure.(ABSTRACT TRUNCATED AT 250 WORDS)