Miniinvasive treatment of lithiasis of the common bile duct hasn't reached yet a standard end point. There are multiple techniques used for it. In this study we evaluate its indications, possibilities and limits.
Material and method: In a series of 14,024 biliary patients operated over 9 years 719 patients underwent open choledocolithotomy. In 173 (1.2%) of patients we used miniinvasive procedures as follows: 71 cases underwent sequential treatment, 91 laparoscopic treatment and in 11 cases the remnant calculi were extracted 1-6 days postoperative.
Results: Sequential treatment was the preferred treatment when the lithiasis of the common bile duct was detected preoperative. Transcistic extraction was more often performed for the lithiasis diagnosed intraoperative. The conversion to open surgery was performed in 13 cases, remnant calculi were early diagnosed in 11 patients and late diagnosed in 14 cases (the calculi were extracted by endoscopic sphyncterotomy). All patients were healed.
Discussions: The miniinvasive procedures have to be practiced as frequently as possible because of rapid healing and early recovery of the patients, despite some disadvantage of them. The choledocotomy and choledocoduodenostomy are exceptional techniques to be used in specific cases.