WHICH DIAGNOSTIC-TESTS BEFORE A CHOLECYSTECTOMY

The need to screen for common bile duc stones depends on which approac h is selected when stones are found in the common bile duct. Laparosco pic surgery and new diagnostic tools tended to modify this approach si nce early 90's. Screening of common bile duct stones is performed pre- or per-operatively and, in both cases, it is undertaken either system atically or selectively. Before the operation an imaging examination i s generally performed: transparietal ultrasonography; intravenous chol angiography; endoscopic retrograde cholangiopancreatography; ultrasoun d endosonography; (+/- spiral) CT cholangiography; or MR cholangiograp hy. During the operation, some arguments favor a systematic intraopera tive cholangiography, others favor a selective approach. For cost-effe ctiveness reasons it is better to perform intra operative cholangiogra phy in a selected subset of patients. Treatment of common bile duct st ones is performed either pre, per or post-cholecystectomy. In case of common bile duct stones, six controlled clinical trials demonstrated t hat one-stage surgical treatment was better than preoperative ERCP fol lowed by cholecystectomy. This approach has not to be changed because of laparoscopic surgery. Three studies, two of which are controlled cl inical trials, demonstrated that laparoscopic surgery of common bile d uct stones is feasible. When a common bile duct stone is suspected, it is not worthwhile to perform a ERCP and an endoscopic sphincterotomy before or after the cholecystectomy.