["500 consecutive cases of laparoscopic cholecystectomy". Argument for the association to endoscopic sphincterotomy: analysis].

Our series of 500 consecutive laparoscopic cholecystectomies has drawn attention to several factors. Results would favor endoscopic sphincterotomy in cases with associated treatment of gall stones in the main bile duct. history taking should search for past history of laparoscopic surgery, especially in men with an extensive pillosity, work-up should include ultrasonography, liver function tests and intravenous cholangiography (in all patients excepting cases of allergy), it is important to use an identical material in a given hospital facility for identical procedures in order to avoid equipment-related conversions, an interesting alternative in emergency situations would be echo-guided transcutaneous transperietal cholecystotomy which allows time for safe opacification, safety is of prime importance and rapide conversion should be made when there is any doubt, especially concerning the main duct, morbidity and mortality in this series were nearly identical to those previously reported large series, for endoscopic sphincterotomy proposed as complementary therapy for cases with associated lithiasis in the main bile duct, 2/3 were performed peroperatively and 1/3 postoperatively. Considering all sphincterotomies, 2/3 were positive with extraction of a stone and demonstration of an enlarged bile duct evidencing recent migration (no failure or iatrogenic event), the relationship between the different elements should allow rapid indications in emergency situations and identify complications immediately (mean hospitalization less than 48 hours) or later. Finally, first intention laparoscopic cholecystectomy can be proposed for patients with signs of biliary distress with lithiasis depite other, sometimes contradictory, conclusions (ANDEM, CPAM, consensus conference). First intention laparoscopic cholecystectomy should eliminate in the future most of the major biliary-pancreatic abdominal syndromes.