Laparoscopic Treatment of Common Bile Duct Stones

Lithiasis disease represents a real public health problem. Indeed, 10% of the general population is asymptomatic carrier of gallbladder stones and among them, 35% will present a symptomatic form which will cause the indication of cholecystectomy. As a result, around 120,000 cholecystectomies are performed per year in France, and around 750,000 in the United States for this indication. Cholecystectomy is therefore the most widely performed procedure in the world. However, in 3 to 20% of cases, common bile duct stones will be associated and to be treated. Different strategies are proposed: a treatment called "all surgical" or an endoscopic treatment (usually a sphincterotomy) before or after a cholecystectomy. The investigators defined three different treatment strategies, representing our three groups of patients: one group with fully laparoscopic surgical treatment (cholecystectomy and laparoscopic exploration of the common bile duct at the same time), one group with laparoscopic cholecystectomy and management of the common bile duct stone(s) by an ERCP performed intraoperatively, and a third group with laparoscopic cholecystectomy and an ERCP performed postoperatively during the same hospital stay. The primary outcome was the morbimortality rate in each group. The secondary outcome was to identify risk factors of failure in the fullfil surgical treatment process.