Different approaches are described in the literature for the detection and treatment of common bile duct stones in patients undergoing laparoscopic cholecystectomy (pre-, intra- or postoperative treatment; combined endoscopic and laparoscopic or total laparoscopic management). No particular "gold standard" treatment can be identified, since too many variables and too many techniques need to be compared. Since it is impossible to establish any single protocol, the reviewing of different large experiences is useful to identify the pros and cons of each procedure. We present the evolution of our own experience over the period 1991-2000 in 1741 patients treated by laparoscopic cholecystectomy for gallbladder stones. We have chosen to assess and treat patients with symptomatic common bile duct stones preoperatively, whereas in the asymptomatic cases we have adopted a protocol that has been modified over the years, consisting first in routine intravenous cholangiography and then in the use of a scoring system which, with the aid of ultrasound data, has allowed us to assess the risk of choledocholithiasis and to administer selective preoperative treatment for common bile duct stones.
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