2014, Number 4
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ABSTRACTCholedocholithiasis may be encountered at the time of laparoscopic cholecystectomy in up to 10 % of young patients and increases to over 25 % in patients aged 60 and older. Once a stone is identified in the main biliary duct, it can become a therapeutic dilemma. Definite algorithms have been established and agreed upon, but international publications continue re-defining the indications for endoscopic retrograde cholangiopancreatography over common laparoscopic bile duct exploration and vice versa. The objective of this study was to present the algorithm for treatment of choledocholithiasis in the National Center of Minimal Access Surgery in Havana. A comprehensive literature review was made on present management of choledocholithiasis with the in situ gallbladder and the results of these techniques achieved in the National Center. The management choices for choledocholithiasis include transcystic common bile duct exploration, laparoscopic common bile duct exploration via choledochotomy, and preoperative and intraoperative endoscopic retrograde cholangiopancreatography with sphincterotomy. Our algorithm for minimally invasive treatment of the choledocholithiasis was presented here. The management of this disease currently depends on the experience of the surgical team and their access to technological advances.
Martin DJ, Vernon DR, Toouli J. Tratamiento quirúrgico versus endoscópico de los cálculos de conductos biliares. Cochrane Database of Systematic Reviews [Internet]. Revisión Cochrane traducida. En: La Biblioteca Cochrane Plus, 2008 Número 4. Oxford: Update Software Ltd. Disponible en: http://www.update-software.com
Maple JT, Ben-Menachem T, Anderson MA, Appalaneni V, Banerjeev S, Cash BD, et al. The role of endoscopy in the evaluation of suspected choledocholithiasis. Guideline. Copyright 2010 by the American Society for Gastrointestinal Endoscopy and by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). Gastrointestinal Endoscopy. 2010;71(1):1-9.
Barreras González JE. La colangiopancreatografía retrógrada con esfinterotomía endoscópica intraoperatoria como modalidad de tratamiento para la coledocolitiasis [tesis]. La Habana: Centro Nacional de Cirugía de Mínimo Acceso. Universidad de Ciencias Médicas de La Habana; 2013. Disponible en: http://tesis.repo.sld.cu/719/
Vázquez-Sequeiros E, González-Panizo F, Boixeda-Miquel D, Milicua JM. Diagnostic accuracy and therapeutic impact of endoscopic ultrasonography in patients with intermediate suspicion of choledocholithiasis and absence of findings in magnetic resonance cholangiography. Rev Esp Enferm Dig. 2011;103(9):464-71.
Noble H, Tranter S, Chesworth T, Norton S, Thompson M. A randomized, clinical trial to compare endoscopic sphincterotomy and subsequent laparoscopic cholecystectomy with primary laparoscopic bile duct exploration during cholecystectomy in higher risk patients with choledocholithiasis. J Laparoendosc Adv Surg Tech. 2009;19:713-20.
McAlister V, Davenport E, Renouf E. Cholecystectomy deferral in patients with endoscopic sphincterotomy. Cochrane Database of Systematic Reviews. [Internet]. In: The Cochrane Library, 2009 Issue 04, Art. No. CD006233. DOI: 10.1002/14651858.CD006233.pub4. Disponible en: http://cochrane.bvsalud.org/cochrane /main.php?lib=COC&searchExp=Cholecystectomy&lang=es