Manejo mini-invasivo de la litiasis coledociana
MINIMALLY INVASIVE SURGERY OF CHOLEDOCHOLITHIASIS
Prensa méd. argent; 104 (2), 2018
Publication year: 2018
Choledocholithiasis is one of the more common benign disorders of the biliary tract
with multiple features of presentation and
several alternatives for its diagnosis and
treatment. Our aim was to perform a based-evidence revision to propose a diagnostic and therapeutic algorithm. The raised
values of gamma glutamiltranspeptidase,
alkaline phosphatase and total bilirubin, are
well predictors for a choledocholithiasis. The
image evidence for a pre-operative detection
with higher sensibility, specificity and better
cost-effectiveness is the cholangioresonance.
For its intraoperative detection, the cholangiography is the method most frequently
used, though cholangioscopy is likewise
useful. In the case of a post-operative suspicious, the cholangiography through the T
tube is the gold standard. With regard to the
treatment of the choledocholithiasis, the different stages are analyzed. depending if the
detection was performed pre, intra or postoperatively. As a conclusion, the approach of
the choledocholithiasis in one step seems to be
better that to perform it in two steps, being
the laparoscopic exploration for bile ducts
stones more safety than the use of the intraoperative ERCP (endoscopic retrograde
cholangiopancreatography) .The postoperative ERCP is not recommended excepting
in very selected cases, and the biliodigestive
derivations should be reserved only for the
primary lithiasis of the common bile duc