Diez estrategias para mejorar la eficacia de la cirugía biliar laparoscópica

Canullán, Carlos M.; Baglietto, Nicolás; Hierro, Pablo Merchán del; Petracchi, Enrique

doi:10.1016/j.ciresp.2020.05.027

Cited by 5 publications

(2 citation statements)

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“…Los factores pronósticos de una litiasis coledociana dificultosa son: un tamaño del cálculo mayor a 2 cm, cálculo impactado, panlitiasis y factores anatómicos como estrechez en vía biliar [10,11]. Según estas características, la estrategia terapéutica puede variar, desde una CPRE con esfinterotomía; litotripsia mecánica; papilotomía y dilatación papilar con balón, que tiene una tasa de éxito entre 65 a 70% [10]; instrumentación transcística durante la resolución quirúrgica, con una tasa de éxito variable de acuerdo al tipo de la dificultad de la litiasis (panlitiasis, calculo enclavado, etc) [12].…”

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“…En más de la mitad de los pacientes con ictericia por coledocolitiasis, los cálculos migran de forma espontánea [15], principalmente cuando estos son menores a 5mm [16]. Sin embargo, no existen reportes, hasta nuestro conocimiento, de migración de litiasis coledocianas dificultosas (un tamaño mayor a 2 cm, cálculo impactado, panlitiasis, y estrechez en vía biliar) [10,11] . El caso presentado corresponde a un macrocálculo (14 x 14 x 28 mm) que migró al intestino delgado, un año después de una CPRE con papilotomía y colocación de stent.…”

Section: Discussionunclassified

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Reporte de Caso Clínico: Migración de cálculo dificultoso

et al. 2021

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BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small stones to the duodenum. However, asymptomatic migration of stones larger than 1cm (macrolithiasis) is atypical. We present a case of migration of a macrocalculus located in the middle of the common bile duct. CASE REPORTS: We present the case of a 27-years-old man, who consulted for postprandial epigastric pain, that started 4 months ago. Abdominal ultrasound showed biliary sludge and common bile duct macrocalculus, with Cholangio-MRI the diagnosis was confirmed. A laparoscopic cholecystectomy with intraoperative cholangiography was performed. EVOLUTION: During the laparoscopic cholecystectomy, no stones were evidenced in the intraoperative cholangiograpy. Due to the disagreement between the preoperative IOC images, transcystic instrumentation with a Dormia basket was performed, without stone extraction. The patient had a favorably evolution, without complications due to the stone migration. Postoperative MRC was performed, without evidence of endoluminal images in the bile duct. CONCLUSIONS: Biliary pathology is dynamic, with the possibility of gallstone migration, even for large gallstones and complicated cases. Although ultrasound and MRI have high sensitivy for diagnosis; IOC is essential to diagnose and treat lithiasic pathology, resolving it in a single operating time, avoiding multiple procedures.

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Section: Discussionunclassified