TREATMENT OF STONES IN THE COMMON BILE-DUCT BY ENDOSCOPIC SPHINCTEROTOMY AND LAPAROSCOPIC CHOLECYSTECTOMY

This paper evaluates the treatment of common bile duct stones by endoscopic sphincterotomy (SE) and laparoscopic cholecystectomy (CL). 733 patients presenting with symptomatic cholelithiasis were operated on between March 1990 April 1993 ; 131 (18 %) of them had a preoperative suspicion of common bile duct stones (LVBP): jaundice for 41, biliary acute pancreatitis for 27 and alterated liver function tests for 63. 131 retrograde cholangiographies (CPRE) were attempted with an associated SE (113 cases) in the presence of LVBP, biliary pancreatitis, enlargement of common bile duct and appearance of forced papilla. CL was performed 24 to 48 heures later. CPRE +/- SE had no mortality; 1 patient presented a retroduodenal perforation of CBD, requiring surgery. 58 cases (44.2 %) of LVBP were diagnosed, without a statistically significant difference according to the clinical pattern. In the group with alterated liver function tests only alkaline phosphatase was significanty predictive of LVBP. There was no mortality or morbidity related to CL; conversion rate was 9.8 % ; 4 of 12 cases of conversion were related to persistence of stones in the common bile duct, without any possibility of laparoscopic extraction. Mean hospital stay was 7.4 days. Efficacy of this sequential method of treatment of LVBP was 91.3 %: this method seems satisfactory, not dangerous and minimally invasive, and should be indicated for pre-operative suspected common bile duct stones.