Treatment of choledocholithiasis: Therapeutic ERCP versus peroperative extraction during laparoscopic cholecystectomy

Limitation for preoperative ERCP/ES before laparoscopic cholecystectomy in patients scheduled for laparoscopic cholecystectomy are (1) Additional inva siveness of endoscopic procedures in patients supposed to he fitted for sur gery, (2) A high rate of useless procedures due to the low predictive value of suspicion criteria for common bile duct stones (CBDS), (3) an inability to detect and treat all patients with CBDS, and (4) so far, an absence of demonstration of the superiority of this split therapeutic approach versus a one stage surgical treatment. Published series of CBDS extraction during laparoscopic cholecystectomy har e included more than 2000 patients. Results and complications of this one s tage laparoscopic approach compares favourably to the conventional open sur gical treatment. In one randomized trial endoscopy plus laparoscopy was not demonstrated superior to laparoscopy alone, Intraoperative diagnosis and treatment of CBDS during laparoscopic cholecys tectomy is the most cost efficient approach for patients with or without pr eoperative suspicion of CBDS, provide they are fitted for surgery.