Combined laparoendoscopic approach for biliary lithiasis treatment

Background/Aims: The treatment of common bile duct stones diagnosed during videolaparoscopic cholecystectomy is still under debate. In cases of suspec ted common bile duct stones, a double approach with endoscopic retrograde c holangiopancreatography either prior to, or following videolaparoscopic cho lecystectomy is the current routine in many centers. An intraoperative endo scopic retrograde cholangiopancreatography with endoscopic papillosphincter otomy and stone extraction has recently been proposed. Methodology: We compared the approaches for suspected common bile duct ston es in 21 cases of combined intervention endoscopic retrograde cholangiopanc reatography during videolaparoscopic cholecystectomy to 17 cases of sequent ial intervention (endoscopic retrograde cholangiopancreatography prior to v ideolaparoscopic cholecystectomy). Complications and postoperative monitori ng are discussed and reported on the basis of hospital stay. Results: Although the efficacy and the complications are similar, patients treated with the sequential approach stayed in the hospital longer because of the double monitoring period during both after endoscopic retrograde cho langiopancreatography and after videolaparoscopic cholecystectomy. Conclusions: A combined approach to suspected common bile duct stones durin g videolaparoscopic cholecystectomy could be an effective and a financially worthwhile treatment.