OPERATIVE TREATMENT OF COMMON BILE-DUCT STONES - LAPAROSCOPIC CHOLECYSTECTOMY AND ENDOSCOPIC TREATMENT

Since 1990, the management of biliary lithiasis has been markedly modi fied by the outstanding success of laparoscopic cholecystectomy. This procedure has become the 'gold standard' for gall bladder lithiasis. E ndoscopic sphincterotomy is still important in common bile duct lithia sis, although the laparoscopic approach, performed in one session with cholecystectomy, is gaining ground. For patients with contraindicatio ns to laparoscopic cholecystectomy or general anaesthesia, other treat ments such as extracorporeal shock-wave lithotripsy or sonoguided tran shepatic percutaneous puncture must be used. These procedures require sophisticated, sometimes costly equipment and particularly well traine d operators. Conventional surgery is becoming confined to cases where other techniques have failed, and is becoming less popular.