Trattamento della cacolosi colecisto-coledocica in tempo unico

The treatment of cholecysto-choledocholithiasis is recently changed from laparotomic common bile duct (CBD) exploration and cholecystectomy to combined method with endoscopic sphincterotomy and laparotomic, then laparoscopic, cholecystectomy. Finally, some authors, proposed different procedures to perform laparoscopic CBD exploration, but currently this is an unroutinary approach because of sophisticated instruments and a good experience of the surgeon are necessary. Undoubtedly for the patient a once and for all solution is the best. For this reason, in our hospital, the endoscopic and surgery teams defined one organizing project (presented to an award of quality improvement called 'Golden Helix Award' 1995 edition) to evaluate the clinical and organizing aspects of endoscopic sphincterotomy and CBD stones extraction performed during laparoscopic cholecystectomy. During one year of experience (from January 1994 to January 1995) 7 cases are enrolled (5 F and 2 M) with anesthesiological risk middle-low, treated all successfully. Only one case had residual stone and underwent 'endoscopic toilette' post-cholecystectomy and one intraoperative hemorrhage from pericholecystic hepatic area, which 2 blood transfusions required. The average length of the procedure was 198 minutes and the average of hospital stay post-surgery was 6.5 days.