Prise en charge de la lithiase de la voie biliaire principale

Choledocholithiasis is a not uncommon and potentially grave condition which requires a well-adapted approach. Echo endoscopy and biliary MRI have improved the ability to make the diagnosis non-invasively, but intraoperative cholangiography remains the most accurate study. A surgical approach permits simultaneous treatment of both choledocholithiasis and the associated cholecystolithiasis; laparoscopic common duct exploration has been more frequently performed through a laparoscopic approach in recent years, but this procedure requires specific equipment and surgical experience. In most circumstances, surgery should be preferred to endoscopic clearance of the common duct, but endoscopy may be preferred in the setting of severe cholangitis or pancreatitis. The importance of a systematic search for asymptomatic choledocholithiasis is once again emphasized.