Laparoscopic One-Stage vs Endoscopic Plus Laparoscopic Management of Common Bile Duct Stones – A Prospective Randomized Study

The incidence of gallstones is rather high and is referred as approximately 13%-17% among the western population, [Bateson, 2000; Barbara et al., 1987; Everhart et al., 1999; Pixley et al., 1985]. It is well known that most of the people with gallstones are asymptomatic and often they are absolutely unaware of their presence, it is even referred that no more than 15-20% of them has the probability of suffering from a biliary colic later on [Attili et al., 1995], which, once occurred, could recur more easily causing sometime serious complications, such as pancreatitis by stone’s migration and biliary obstruction, that over a 10-year period can be expected to occur in 2–3% of patients with initially silent gallbladder stones [Gracie & Ransohoff, 1982]. The incidence of common bile duct (CBD) stones has been reported as ranging between 5% to 18% of patients undergoing cholecystectomy for gallstones, and patients with symptoms suggestive of choledocholithiasis have an even higher incidence, also increasing with age [Martin et al., 2006]. Because of the continuous developing of the diagnostic and therapeutic techniques from the introduction of intra-operative cholangiography by Mirizzi in 1932, the choose of the most effective strategy in the management of the common bile duct (CBD) stones associated with gallstones is object of close discussions far from any conclusive agreement. The new diagnostic techniques as magnetic resonance cholangiography (MRC) and endoscopic ultrasound (EUS), give the opportunity to visualize the biliary tree without any invasive exploration of the ducts and share the same idea as the minimally invasive laparoscopic surgical approach. They are progressively evolving as well as the standard of care for the management of common bile duct (CBD) stones, historically performed via