[Actual status of laparoscopic cholecystectomy]. / Estado actual de la colecistectomía laparoscópica.

INTRODUCTION: Since the first laparoscopic cholecystectomy in 1988, the management of gall-bladder disease has changed importantly. This technique was rapidly popularized in the U.S. as well as in Europe. Multiple studies have proved its feasibility, safeness and great advantages. OBJECTIVE: Analyze usefulness and recent advances of endoscopic surgery in the management of gallbladder disease. METHODS: We did a review of the recent medical literature to determine the actual status of laparoscopic cholecystectomy. RESULTS: Laparoscopic cholecystectomy is the most common surgical procedure performed in the digestive tract. During the year 2001, 1,100,000 cholecystectomies were done in the U.S., 85% were done laparoscopically. In Mexico cholecystectomy in government hospitals is done laparoscopically in 50% of the cases, while in private hospitals it reaches 90%. There are multiple prospective controlled studies showing superiority of laparoscopic cholecystectomy in times of recovery, costs, return to normal activity, pain, morbidity, esthetics among other advantages. CONCLUSIONS: Laparoscopic cholecystectomy is the gold standard for the treatment of the great majority of cases of gallbladder disease, nevertheless in developing countries open cholecystectomy is still done frequently.

[Bile duct laparoscopic exploration]. / Exploración laparoscópica de vías biliares.

The use of ERCP with endoscopic esphincterotomy (ES) for the management of choledocholithiasis has replaced almost completely common bile duct exploration in the era of laparoscopic cholecystectomy. Once the procedure is completed it is followed by laparoscopic cholecystectomy in the same hospitalization. During the last few years, the development of new technology and equipment with possibilities of minimal invasive procedures and diagnosis, as well as the ongoing surgical skills has allowed surgeons to solve the problem of choledocholithiasis in one minimal invasive procedure, decreasing effectively morbidity with a high success rate, changing again ERCP with ES as a complement and not as a substitute for surgery. Nevertheless the initial step in the use of these techniques require of a special technical support and what is most important capacitation to achieve the desire objectives. Transcystic technique seems to be the most promising and choledochotomy with primary closure in cases that cannot be solved with the transcystic approach. Regardless of the approach the surgeon must be familiar with both and increasingly with the use of the endoscope in order to provide patients with advantages of minimal invasive surgery and all its advantages. We also discuss our series of 81 patients operated on with laparoscopic surgery with a high rate of success, low morbidity and mortality.