[Role of laparoscopy in the current treatment of lithiasis of the common bile duct. Apropos of 63 cases of lithiasis].

The purpose of this study is to evaluate the operative technique, indications and results of laparoscopic management of common bile duct (CBP) stones. While laparoscopic cholecystectomy has become the procedure of choice for gallstones, the management of CBD stones remains controversial. From October 1989 to may 1993, we performed 634 cholecystectomies, 615 of them carried out by laparoscopy, (97%). We found 63 cases of CBD stones (9.9%). At the beginning, CBD stones were managed either by endoscopic sphincterotomy (12 cas) or by laparotomy (6 cas). We subsequently performed laparoscopic treatment of CBD stones. Forty-six patients have been treated in this way: 17 via a transcystic approach successfully in 14 cases (82.3%) and 29 by choledochotomy with 27 successful extractions (93.1%). There was no mortality and a morbidity of 4.3% (1 retained stone and 1 wound infection). Endoscopic sphincterotomy is indicated in high risk elderly patients and in complicated stones. (pancreatitis cholangitis), while the whereas incidence of open surgery is greatly reduced; the advantages of laparoscopic management of CD stones are its noninvasive aspect and the complete clearance of the stones in one operation.