Opciones terapéuticas actuales en el manejo de la coledocolitiasis asociada a colecistolitiasis
Current therapeutic options in the management of choledocholithiasis associated with cholecyllithiasis
Rev. Hosp. Clin. Univ. Chile; 28 (3), 2017
Publication year: 2017
The term Choledocholithiasis refers to the presence of biliary stones in the extrahepatic bile
ducts, which are found in 5 to 10% of patients undergoing cholecystectomy for gallstones.
Nowadays, with the adoption of the laparoscopic cholecystectomy(LC) as a standard, multiple
minimally invasive treatment options for bile duct stones are feasible, with no consensus to
date on the procedure of choice. The two stage endoscopic techniques involve the use of
Endoscopic Retrograde Cholangiopancreatography(ERCP) before or after performing a LC,
which has the main advantage of separating the bile duct procedure from the LC. However, the
need for two separate anesthesia times, the possibility of blank or failed ERCP, and the chance
for calculi migration between procedures increase the length of hospital stay and associated
costs. The single stage procedures include the Laparoscopic Bile Duct Exploration (LBDE),
and more recently, the performance of a laparoscopy guided intraoperative ERCP(Rendez
Vous). The LBDE, when performed by an experienced surgical team, is an effective and safe
technique. Nonetheless, it is considered a technically demanding procedure, whose results
cannot be extrapolated to the general surgical community. Recently, the Rendez Vous has
become a treatment alternative that simplifies both the surgical and the endoscopic procedures,
decreases morbidity, and requires a single anesthesia time. On the downside, Rendez Vous
technique involves complex operating room (OR) logistics, requiring both a trained surgical and
endoscopic team at the same time. (AU)