[The laparoscopic treatment of common bile duct lithiasis].
Nowadays the laparoscopic cholecystectomy has become the main surgical therapy in the treatment of cholecysto-lithiasis. At the beginning the treatment of cholecysto-choledochal lithiasis was the sequential endoscopic-laparoscopic therapy. In fact, the endoscopic sphincterotomy allows transpapillary ablation of Common Bile Duct (CBD) stones, and the laparoscopic cholecystectomy completes the therapy. Recently we have brought the full-laparoscopic of CBD lithiasis. This has become possible on account of an improved intraoperative laparoscopic diagnostics and a better technical experience of the laparoscopic surgeon. Intraoperative examination of CBD requires suitable instruments: cholangiography is still a basic examination and now is easily performed in laparoscopy without a considerable increase of the surgical time; choledochoscopy allows an intraluminal inspection of completes the examination, supplying further detailed information. Afterwards the laparoscopic approach allows the transcystic ablation of stones, using a Dormia probe or through a choledochotomy, but is previously required for the surgeon a high-level operative and technical ability about laparoscopic surgery, in order to perform an excellent preparation of the CBD and precise stitches, making knots with extra corporeal or intra-abdominal technique. Clinical results in patients until now fully-laparoscopic treated are quite good and encourage the CBD lithiasis therapy by a mini-invasive approach, which has the advantage that's not requested the sacrifice of a sound papilla.
Liguori
L
L
Divisione di Chirurgia Generale, Ospedale Maggiore C. A. Pizzardi, Bologna.
Cucchi
M C
MC
Fonti
G
G
Garulli
G
G
Ucchino
G
G
D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D003135:Common Bile Duct / Q000000981:diagnostic imaging / Q000601:surgery; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D012008:Recurrence