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Background: There are many different strategies for the treatment of the main bile duct lithiasis. When lithiasis of the biliary tract is suspected at a preoperative stage, we can treat patients with sequential treatment: endoscopic netrograde cholangiopancreatography followed by laparoscopic cholecystectomy. If common bile duct-lithiasis is recognized at an intraoperative stage, many options for treatment exist, one of which is intraoperative retrograde endoscopic sphincterotomy (ES) (laparoendorendezvous)., Methods: We report our experience using the aforementioned technique with 58 patients affected by cholelithiasis and complex Common bile duct disease who underwent laparoscopic cholecystectomy and intraoperative ES consecutively from March 1996 to May 2000. Of the 58 patients, 43 were affected by cholecystocholedocolithiasis: 12 by previously described lithiasis plus stenosant papillitis, 2 also by a pancreas head cancer, and 1 by cancer of the papilla., Results: The combined technique was performed in 86% of the cases. Six patients required conversion to open surgery. In two other patients, laparoscopic choledocotomy was performed with positioning of a Kehr-tube for an ampulla-impacted lithiasis., Conclusions: Intraoperative ES offers a valid approach to the treatment of cholecystocholedocolithiasis in one session. Furthermore, it represents a valid alternative to transcholedocical laparoscopic treatment of cholelithiasis and complex common bite duct pathology.

On the basis of personal experience (104 LTC and 88 ERCP), the value of direct cholangiography in the diagnosis of biliary lithiasis especially in the event of failure of traditional radiology and in the presence of icterus is confirmed. LTC in 37 patients and ERCP in 18 revealed calculosis of the bile ways, thus correcting a falsely negative echography and i.v. cholangiography to the extent of 70% and 25% respectively. Stress is laid on the importance of direct cholangiography because it is able to establish the site of the stones and, above all, the pathology associated with calculosis, involving not only the bile ways, but the papilla, pancreas and liver too.