Minimally invasive treatment of cholecysto-choledocal lithiasis: The point of view of the surgical endoscopist

Table 1 Management strategies of minimally invasive treatment of cholecysto-choledocal lithiasis

One step surgical treatment	Laparoscopic
Endoscopic + surgical approach	Preoperative ERCP
	Intraoperative ERCP
	Postoperative ERCP
Endoscopic treatment alone1	Endoscopic stones extraction without subsequent cholecystectomy

¹Selected patients. ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Discussion overview of management strategies

Type of procedure	Advantages	Disadvantages
ERCP + ES	Less invasive	Equipment
	Procedure of choice in post-cholecystectomy	Local expertise
	patients, acute cholangitis, gallstone pancreatitis	2 stage procedure
		Complications
LCBDE: transcystic	Minimal invasive	Equipment
	One stage procedure	Local expertise
		Anatomic variations
		Prolonged OR time
LCBDE: choledochotomy	One stage procedure	Most invasive
		Necessitate of T-tube
		Prolonged OR time

ERCP: Endoscopic retrograde cholangiopancreatography; ES: Endoscopic sphincterotomy; LCBDE: Laparoscopic common bile duct exploration; OR: Operative time.