Different methods, all of which equally efficacious and safe, can be selected to access the choledochus in patients with cholecysto and choledocholithiasis on the basis of clinical and anatomosurgical parameters. From 1990 we evaluated three groups of patients who underwent surgery at different times and with different methods: sequentially (endoscopic sphincterotomy and laparoscopic cholecystectomy), one step laparoscopy and combined laparo-endoscopy. The results obtained seem to show that the treatment with laparoscopy alone is the most advantageous in terms of cost-benefit, while the endoscopic access of the choledochus during laparoscopic cholecystectomy is the one to prefer in terms of efficacy and safety.