Laparoscopic intraoperative cholangiography for common bile duct lithiasis associated to calculous cholecystitis

Background and study aims: The aim of this study was to evaluate the efficacy and safety of the laparoscopic common bile duct exploration performed within 24 hours from the urgent hospitalisation of patients with calculous cholecystitis associated to choledocholithiasis either proven or suspected. Patients and methods: From November 2010 to May 2012, 126 patients hospitalised at the Regional Hospital of Orleans (France) were retrospectively reviewed. All patients were preoperatively assessed only by means of routine blood tests and abdominal ultrasounds. Results: In our study were collected: 67 choledochotomies and 59 transcystic approaches; the laparoscopic procedure was successfully achieved in 97.6% of the cases. Statistical significant differences were found about common bile duct dilatation (P<0.05) and in-hospital stay (P<0.001). Conclusion: We suggest that the laparoscopic-first approach for choledocholithiasis, realised in specialised centres by skilled surgeons in hepato-biliary diseases, represents a feasible, safe and cost-effective management also in patients urgently admitted and treated for acute calculous cholecystitis.