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The authors report their experience of 48 consecutive cases of colecystectomy performed using a videolaparoscopic technique. Laparoscopic surgery was not successful in only two patients in whom it was necessary to resort to laparotomy; bile duct injury occurred in one patient. On the basis of their experience the authors conclude by affirming that this videolaparoscopic technique may be applied to almost all patients requiring cholecystectomy since it offers considerable advantages over traditional techniques.

Reconstructive surgery of the bile ways involves a great commitment owing to the technical difficulties, the diversity of the nature, site and extent of the alteration to be treated, and because of the particular anatomical structure of the formations which have to be operated. The conditions that can benefit most from this type of surgery are represented by preoperative lesions of the bile ways and particularly stenoses which but not only follow such lesions if they are not treated in time, but may also follow other processes of a benign nature such as calculosis, cholangitis, anomalies of the bile ways treated wrongly during previous cholecystectomy, and at times malignant processes. Reconstructive surgery in bile way surgery means direct re-establishment of the duct to enable bile to flow from the liver to the duodenum. It presupposes a number of local conditions, such as the circumscription of the condition so that the stenotic segment can be removed and long-lasting end-to-end anastomosis effected. When it is possible, this must be considered the ideal procedure since it offers anatomophysiological recovery of bile way function. Operations have also been performed using various vein, artery, appendix, fascia lata, etc. grafts and prostheses using foreign matter such as rubber, vitallium,dacron, etc. tubes but results have always been hazardous and debatable. Personal cases and techniques are reported.

Following an aetiopathogenetic and physiopathological discussion of biliary peritonitis, a statistical analysis of the main clinical symptoms observed is presented on the basis of 37 personal cases with a view to highlighting diagnostic factors capable of identifying a disease process which may easily be confused with other acute abdominal diseases. The need to intervene as quickly as possible is finally noted.