>Year 2018, Issue 3
González-Pérez LG, Zaldívar-Ramírez FR, Tapia-Contla BR, Díaz-Contreras-Piedras CM, Arellano-López PR, Hurtado-López LM
Risk factors of asymptomatic choledocholithiasis; experience in the General Hospital of Mexico
Cir Gen 2018; 40 (3)
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Background: Choledocholithiasis is the most common cause of obstruction of the bile ducts in patients with cholelithiasis. Without jaundice or dilation of the bile duct, the diagnosis is extremely difficult to suspect; it is possible for them to be diagnosed during surgery or time after it. Cholangioresonance or endoscopic retrograde cholangiopancreatography are reserved for cases with a high index of suspicion of choledocholithiasis. They are not performed routinely.
Objective: To know the risk factors for asymptomatic choledocholithiasis in patients undergoing laparoscopic cholecystectomy.
Material and methods: A prospective, analytical, comparative study was performed in patients who underwent laparoscopic cholecystectomy without clinical or radiological evidence to suspect choledocholithiasis. Based on the transoperative cholangiography, they were divided into two groups: without choledocholithiasis and with choledocholithiasis; p ‹ 0.05 was considered statistically significant.
Results: 53 women (77.9%) and 15 men (22.1%). Alkaline phosphatase (AP) was the only parameter with significant difference between the groups (p = 0.034). With AP › 90.5 U/l, there was a 12.4-fold greater risk of presenting asymptomatic choledocholithiasis, with sensitivity and specificity of 80%.
Conclusions: Asymptomatic choledocholithiasis in the General Hospital of Mexico is 13.2%. When a patient with cholelithiasis, without jaundice and without ultrasonographic dilation of the bile duct has AP › 90.5, we should suspect the presence of asymptomatic choledocholithiasis.
||Asymptomatic choledocholithiasis, minimal invasion surgery.
Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterology Clin North Am. 2010; 39: 157-169.
Méndez-Sánchez N, Jessurun J, Ponciano-Rodríguez G, Alonso-De-Ruiz P, Uribe M, Hernández-Avila M. Prevalence of gallstone disease in Mexico. Dig Dis Sci. 1993; 38: 680-683.
Pucher PH, Brunt LM, Fanelli RD, Asbun HJ, Aggarwal R. SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy. Int Surg Endosc. 2015; 29: 3074-3085.
Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis. Int J Surg. 2015; 18: 196-204.
Collins C, Maguire D, Ireland A, Fitzgerald E, O’Sullivan GC. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg. 2004; 239: 28-33.
Jamal KN, Smith H, Ratnasingham K, Siddiqui MR, McLachlan G, Belgaumkar AP. Meta-analysis of the diagnostic accuracy of laparoscopic ultrasonography and intraoperative cholangiography in detection of common bile duct stones. Ann R Coll Surg Engl. 2016; 98: 244-249.
Van Baal MC, Besselink MG, Bakker OJ, van Santvoort HC, Schaapherder AF, Nieuwenhuijs VB, et al. Timing of cholecystectomy after mild biliary pancreatitis: a systematic review. Ann Surg. 2012; 255: 860-866.
Wild JL, Younus MJ, Torres D, Widom K, Leonard D, Dove J, et al. Same-day combined endoscopic retrograde cholangiopancreatography and cholecystectomy: achievable and minimizes costs. J Trauma Acute Care Surg. 2015; 78: 503-507.
Mallick R, Rank K, Ronstrom C, Amateau SK, Arain M, Attam R, et al. Single-session laparoscopic cholecystectomy and ERCP: a valid option for the management of choledocholithiasis. Gastrointestinal Endosc. 2016; 4: 639-645.
Pan L, Chen M, Ji L, Zheng L, Yan P, Fang J, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis. Ann Surg. 2018; 268: 247-253. doi: 10.1097/SLA.0000000000002731. [Epub ahead of print] https://www.ncbi.nlm.nih.gov/pubmed/29533266 (Abril 2018).
Sirinek KR, Schwesinger WH. Has intraoperative cholangiography during laparoscopic cholecystectomy become obsolete in the era of preoperative endoscopic retrograde and magnetic resonance cholangiopancreatography? J Am Coll Surg. 2015; 220: 522-528.
Fanelli RD, Andrew BD. Making the diagnosis: surgery, a rational approach to the patient with suspected CBD stones. In: Hazey J, Conwell D, Guy G. (eds) Multidisciplinary management of common bile duct stones. Springer. 2016, 37-48.
Baucom RB, Feurer ID, Shelton JS, Kummerow K, Holzman MD, Poulose BK. Surgeons, ERCP, and laparoscopic common bile duct exploration: do we need a standard approach for common bile duct stones? Surg Endosc. 2016; 30: 414-423.
Koc B, Karahan S, Adas G, Tutal F, Guven H, Ozsoy A. Comparison of laparoscopic common bile duct exploration and endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for choledocholithiasis: a prospective randomized study. Am J Surg. 2013; 206: 457-463.
Faul F, Erdfelder E, Lang A, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007; 39: 175-191.
Sethi S, Wang F, Korson AS, Krishnan S, Berzin TM, Chuttani R, et al. Prospective assessment of consensus criteria for evaluation of patients with suspected choledocholithiasis. Dig Endosc. 2016; 28: 75-82.
Sotelo EJ, Souza GL, Alanis ME, Salas GA, Cancino LJ. Colecistectomía laparoscópica con exploración coledocoscópica y cierre primario de la vía biliar como opción terapéutica en coledocolitiasis. Reporte de un caso. Rev Mex Cir Endoscop 2016; 17: 196-199.
Benites HG, Palacios FS, Asencios JC, Aguilar RM, Segovia NV. Performance of ASGE predictive criteria in diagnosis of choledocholithiasis in the Edgardo Rebagliati Martins Hospital. Rev Gastroenterol Perú [Online]. 2017; 37: 111-119.
Pacahuala CM, Trujillo HJ, Méndez SC. Colangiografía transoperatoria selectiva. Factores asociados a coledocolitiasis. Rev Med Inst Mex Seguro Soc. 2003; 41: 159-163.
Hope WW, Fanelli R, Walsh DS, Narula VK, Price R, Stefanidis D, et al. SAGES clinical spotlight review: intraoperative cholangiography. Surg Endosc. 2017; 31: 2007-2016.
>Year 2018, Issue 3