Treatment of choledochal lithiasis by laparoscopy, a case series of the Surgical Clinic 2 of the Maciel Hospital

Tratamiento de la litiasis coledociana por vía laparoscópica, serie de casos de la Clínica Quirúrgica 2 del Hospital Maciel

Moreira, Emilia - Pontillo, Mauricio - Hernández, Rodrigo - Rodríguez Temesio, Gustavo

Resumen:

Background: Biliary lithiasis is a high prevalence disease among general population being one of the most common surgical cause to attend to ambulatory appointment or to the emergency room. Due to the disease high prevalence and the potential complications,  treatment is indicated. The best treatment option is still a matter of debate, admitting either surgical, endoscopic or percutaneous treatment. The aim of this series was to present the surgical management of choledocholithiasis, either as symptomatic presentations or as an incidental finding during intraoperative colangiography, at Surgical Clinic 2, Maciel Hospital. Methods: An electronic search was done among all colecistectomie's records between January 1st and October 7th, 2018, selecting those with choledocholithiasis confirmed by intraoperative cholangiography. Results: 115 colecystectomy were done in the time period previously mentioned, 113 patients had laparoscopic colecistectomies and 2 patients had open conversions, choledocholitiasis was confirmed in 20 cases. Stone clearance was done with Dormia basket, angioplasty balloon catheter, Randall stone forceps and flushing with saline, it was successful in 18 cases. Discussion: Either transcistic or choledochotomy approach allowed to solve the disease in one surgical act. Intraoperative cholangiography was successful in 80% of cases and lithiasis extraction was complete in 90% of cases, no difference with previous published works found. Conclusions: Transcystic or choledochotomy approach is a safe and effective treatment


Introducción: La enfermedad litiásica es una patología con alta prevalencia en la población general siendo uno de los principales motivos de consulta de cirugía general tanto en policlínica como en emergencia. Dada su alta prevalencia y las potenciales complicaciones está indicado su tratamiento, siendo el ideal aún controvertido, pudiendo ser quirúrgico, endoscópico o percutáneo. El objetivo del trabajo consistió en la presentación del tratamiento de la litiasis coledociana realizado en la Clínica Quirúrgica 2 del Hospital Maciel, valorando su eficacia y las complicaciones halladas.  Materiales y métodos: Se realizó una búsqueda electrónica de todas las descripciones operatorias de colecistectomías realizadas entre el 1ro de enero y el 7 de octubre del 2018 seleccionándose las que presentaron confirmación colangiográfica de litiasis a nivel de la vía biliar principal.  Resultados: Se realizaron 115 colecistectomías, 113 laparoscópicas, 2 requirieron conversión hallándose litiasis a nivel de vía biliar principal en 20 casos. Los tratamientos de las mismas fueron mediante Dormia, balón de angioplastia, pinzas de Randall y lavado con suero fisiológico siendo exitoso en 18 casos. Discusión: El abordaje de la vía biliar principal tanto transcística como mediante coledocotomía permite la resolución integral de la patología litiásica en un solo acto. La colangiografía se realizó de forma exitosa en el 80% de los casos y mediante las modalidades utilizadas se logró la extracción de los litos en el 90%, no se halló diferencia respecto a otros trabajos publicados. Conclusiones: El tratamiento tanto transcístico como mediante coledocotomía puede ser realizado de forma segura y efectiva.


Detalles Bibliográficos
2020
litiasis coledociana
exploración vía biliar principal
tratamiento
Choledocholithiasis
main bile duct examination
treatment
Español
Sociedad de Cirugía del Uruguay
Revista Cirugía del Uruguay
https://revista.scu.org.uy/index.php/cir_urug/article/view/1804
Acceso abierto
Resumen:
Sumario:Background: Biliary lithiasis is a high prevalence disease among general population being one of the most common surgical cause to attend to ambulatory appointment or to the emergency room. Due to the disease high prevalence and the potential complications,  treatment is indicated. The best treatment option is still a matter of debate, admitting either surgical, endoscopic or percutaneous treatment. The aim of this series was to present the surgical management of choledocholithiasis, either as symptomatic presentations or as an incidental finding during intraoperative colangiography, at Surgical Clinic 2, Maciel Hospital. Methods: An electronic search was done among all colecistectomie's records between January 1st and October 7th, 2018, selecting those with choledocholithiasis confirmed by intraoperative cholangiography. Results: 115 colecystectomy were done in the time period previously mentioned, 113 patients had laparoscopic colecistectomies and 2 patients had open conversions, choledocholitiasis was confirmed in 20 cases. Stone clearance was done with Dormia basket, angioplasty balloon catheter, Randall stone forceps and flushing with saline, it was successful in 18 cases. Discussion: Either transcistic or choledochotomy approach allowed to solve the disease in one surgical act. Intraoperative cholangiography was successful in 80% of cases and lithiasis extraction was complete in 90% of cases, no difference with previous published works found. Conclusions: Transcystic or choledochotomy approach is a safe and effective treatment