Abordaje laparoscópico sistemático de la coledocolitiasis

Abstract

Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithiasis and 92.9% for other diagnoses. The rate of complications was 4% without deaths or bile duct injuries. Conclusion: Single-stage laparoscopic surgery is an efficient and safe approach based on the high global success of transcystic exploration. The preoperative diagnosis of choledocholithiasis reduces the efficacy of the procedure due to greater indication of choledocotomy, with complications and longer length of hospital stay.

Coledocolitiasis resuelta por laparoscopía. Reporte de un caso

“…Several studies, both regional and international, conclude that choledochotomy and extraction of calculus with or without placement of a T-tube for draining is a safe option of treatment 2,4-7 and according to the findings of Yegros-Ortiz et al 7 there is no significant difference in the morbi-mortality with or without the placement of the T-tube after the choledochotomy. Canullan et al 2 proposes the efficacy superiority of the transcystic approach of extraction over the transcholedocian approach.…”