TREATMENT OF STONES IN THE COMMON BILE-DU CT BY ENDOSCOPIC SPHINCTEROTOMY AND LAPAROSCOPIC CHOLECYSTECTOMY

This paper evaluates the treatment of common bile duct stones by endos copic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 p atients presenting with symptomatic cholelithiasis were operated on be tween March 1990 April 1993 ; 131 (18 %) of them had a preoperative su spicion of common bile duct stones (LVBP): jaundice for 41, biliary ac ute pancreatitis for 27 and alterated liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlarge ment of common bile duct and appearance of forced papilla. CL was perf ormed 24 to 48 heures later. CPRE +/- SE had no mortality; 1 patient p resented a retroduodenal perforation of CBD, requiring surgery. 58 cas es (44.2 %) of LVBP were diagnosed, without a statistically significan t difference according to the clinical pattern. In the group with alte rated liver function tests only alkaline phosphatase was significanty predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8 % ; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibil ity of laparoscopic extraction. Mean hospital stay was 7.4 days. Effic acy of this sequential method of treatment of LVBP was 91.3 %: this me thod seems satisfactory, not dangerous and minimally invasive, and sho uld be indicated for pre-operative suspected common bile duct stones.