PLACE OF LAPAROSCOPY IN THE CURRENT TREAT MENT OF STONES OF THE COMMON BILE-DUCT - STUDY OF 63 CASES

The purpose of this study is to evaluate the operative technique, indi cations and results of laparoscopic management of common bile duct (CB P) stones. While laparoscopic cholecystectomy has become the procedure of choice for gallstones, the management of CBD stones remains contro versial. From October 1989 to may 1993, we performed 634 cholecystecto mies, 615 of them carried out by laparoscopy, (97 %). We found 63 case s of CBD stones (9,9 %). At the beginning, CBD stones were managed eit her by endoscopic sphincterotomy (12 cas) or by laparotomy (6 cas). We subsequently performed laparoscopic treatment of CBD stones. Forty-si x patients have been treated in thirway : 17 via a transcystic approac h successfully in 14 cases (82,3 %) and 29 by choledochotomy with 27 s uccessful extractions (93,1 %). There was no mortality and a morbidity of 4.3 % (I retained stone and 1 wound infection). Endoscopic sphinct erotomy is indicated in high risk elderly patients and in complicated stones. (pancreatitis cholangitis), while the whereas incidence of ope n surgery is greatly reduced ; the advantages of laparoscopic manageme nt of CD stones are its noninvasive aspect and the complete clearance of the stones in one operation.