ORIGINAL ARTICLES   

Chirurgia 1999 October;12(5):327-32

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Evolution of cholecystocholedocholithiasis treatment in Piemonte between 1992 and 1997

Guglielminotti P., Brachet Contul R., Giraudo G., Morino M.

Background. Evaluation of current management of cholecystocholedocholithiasis in an homogeneous area.
Methods. In 1997 in Piedmont among 4601 cholecystectomies, 553(12%) patients with gallbladder and common bile duct stones were treated in 35 Surgical Departments. Common bile duct stones were diagnosed preoperatively in 435 patients (1st group, 79%), intraoperatively in 118 cases (2nd group, 21%).
Results. In the first group, endoscopic retrograde cholangio-pancreatography (ERCP) with endoscopic sphincterotomy (ES) followed by laparoscopic cholecystectomy (LC) was the treatment of choice for 355 (77%) patients. Eighty-five (20%) patients were treated by complete open surgery; only 6 (1%) were treated by one-stage laparoscopy, either by a transcystic approach or by laparoscopic choledochotomy. The endo-laparoscopic technique was performed in 9 (2%) cases. In the second group, 78 (66%) patients were treated by laparotomic approach; mini-invasive approaches were applied in 40 (34%) patients.
Conclusions. Sequential minimal invasive treatment and open surgery are the standard approaches to preoperative and intraoperative diagnosed cholecystocholedocholithiasis. One-stage management of common bile duct stones, either laparoscopic or endoscopic-laparoscopic, is at present confined to advanced laparoscopic surgical Departments.