Patient Evaluation and Management With Selective Use of Magnetic Resonance Cholangiography and Endoscopic Retrograde Cholangiopancreatography Before Laparoscopic Cholecystectomy

Effectiveness of Laparoscopic Surgery for Gallstones and Common Bile Duct Lithiasis: a Systematic Overview

“…For low-risk patients the one-step laparoscopic treatment has progressively been incorporated into clinical practice. Furthermore, the use of biliary endoprosthesis after bile duct laparoscopic exploration may be a safe and effective alternative as compared with the implantation of a Kehr tube (Low quality evidence) (Smith, 1997;Joyce, 1991;Prat, 1996;Costi, 2007;Trondsen, 1998;Liu, 2001;Cuschieri, 1999;Wei, 2003;Gurusamy, 2007;Griniatsos, 2005;KimK, 2004;Lien, 2005;Decker, 2003;Fanelli, 2001).…”

“…It is generally accepted that two-stage surgery (endoscopic papillotomy followed by LC) is the most appropriate strategy for high-risk patients, such as those with cholangitis and pancreatitis (Liu, 2001). However, for low risk patients, a one-step strategy has progressively been adopted in clinical practice, this involves LC and laparoscopic bile duct exploration (transcystic or via choledochotomy).…”

Management of suspected stones in the common bile duct

“…It was used to select the approach to imaging and management: ERCP if the probability is extremely high, magnetic resonance cholangiopancreatography if it is high, laparoscopic cholecystectomy with intraoperative cholangiography if it is intermediate, and laparoscopic cholecystectomy without intraoperative cholangiography if the probability is low. 6 The use of this stratification system re sulted in the discriminatory detection of stones in 92.6%, 32.4%, 3.8% and 0.9% of the patients respectively. 6 The proportion of patients with retained stones after two years was 1.4%.…”

“…6 The use of this stratification system re sulted in the discriminatory detection of stones in 92.6%, 32.4%, 3.8% and 0.9% of the patients respectively. 6 The proportion of patients with retained stones after two years was 1.4%.…”

A colangiopancreatografia por ressonância magnética deve substituir a colangiopancreatografia endoscópica retrógrada no algoritmo diagnóstico das doenças biliopancreáticas?

“…Finalmente, aqueles de baixo risco, seriam submetidos a colangiografia intra-opeatória. LIU et al (4) , utilizando algoritmo semelhante, aplicou a CPER em 27 de 440 pacientes (6%), encontrando coledocolitíase em 25 deles (93%). Por outro lado, indicou a CPRM para 37 pacientes (8%), encontrando coledocolitíase em 32% deles.…”