The “Ideal” Treatment of Cholecysto-Choledocholithiasis Remains Unsolved after more than 30 years of Experience?

The advent of endoscopic techniques changed surgery in many regards.In the management of cholelitiasis tle Laparoscopic Cholecystectomy (LC)is today the treatment of choice.This has created a dilemma in the management of choledocholitiasis .Today a number of option exist including Laparoscopic Common Bile Duct Exploration (LCBDE) by the transcystic approach or laparoscopic choledocotomy, open CBDE and postoperative Endoscopic Retrograde Cholangiopancreatography (ERCP) associated with endoscopic sphyncterotomy (ES) in case of residual stones.However, whenever feasible, the one-stage approach through the Laparoendoscopic Technique, Rendezvous (LERV) offers some advantages which induced us to prefer it as our first choice. Materials and Methods:This study was carried out on 10.980 patients with gall bladder stones and with suspected or confirmed CBD stones.In 10.698 (97,4%) of them Intraoperative Cholangiography (IOC) was carried out.A preoperative diagnosis was obtained in 1638 (89,5%) patients while in 193 (10,5) the choledocholitiasis occurred occasionally during the operation due to CIO being performed.The treatment over the years has included Laparoscopic Cholecystectomy (LC) preceded or followed by ERCP with ES, subsequently LCBDE, and in the last ten years a single-stage LERV. Conclusions:Our experience gained over all these years has allowed us to conclude that the treatment of cholecysto-choledocal stones in a single-stage by LERV technique is a safe procedure with a high success rate like other methods but with some major advantages such as a shorter hospital stay and complications and the need for multiple anesthesia sessions and hospital admissions within a short interval.