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| Surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the “rendezvous” technique |
| Giuseppe Tarantino, Paolo Magistri, Roberto Ballarin, Giacomo Assirati, Antonio Di Cataldo and Fabrizio Di Benedetto |
Modena, Italy
Author Affiliations: Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy (Tarantino G, Magistri P, Ballarin R, Assirati G and Di Benedetto F); Department of General Surgery, Sapienza-University of Rome, 00189 Rome, Italy (Magistri P); and Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania, 95124 Catania, Italy (Di Cataldo A)
Corresponding Author: Giuseppe Tarantino, MD, Hepato-Pancreato-Biliary Surgery and Liver Tranplantation Unit, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124 Modena, Italy (Tel: +39-0594225265; Email: tarantino.g@hotmail.it) |
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Abstract BACKGROUND: According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones (CBDS) in patients with symptomatic cholelithiasis is estimated to be 10% to 33%, depending on patient’s age. Compared to stones in the gallbladder, the natural history of secondary CBDS is still not completely understood. It is not clear whether an asymptomatic choledocholithiasis requires treatment or not. For many years, open cholecystectomy with choledochotomy and/or surgical sphincterotomy and cleaning of the bile duct were the gold standard to treat both pathologies. Development of both endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery, together with improvements in diagnostic procedures, influenced new approaches to the management of CBDS in association with gallstones.
DATA SOURCES: We decided to systematically review the literature in order to identify all the current therapeutic options for CBDS. A systematic literature search was performed independently by two authors using PubMed, EMBASE, Scopus and the Cochrane Library Central.
RESULTS: The therapeutic approach nowadays varies greatly according to the availability of experience and expertise in each center, and includes open or laparoscopic common bile duct exploration, various combinations of laparoscopic cholecystectomy and ERCP and combined laparoendoscopic rendezvous.
CONCLUSIONS: Although ERCP followed by laparoscopic cholecystectomy is currently preferred in the majority of hospitals worldwide, the optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers.
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2017, Vol. 16 
