1. Treatment of choledocolithiasis by laparoscopic exploration of the bile tract after failed endoscopic retrograde cholangiopancreatography
- Author
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Karla Belén Molina Tabárez, Diana Luis Sánchez, Arcenio Luis Vargas Ávila, Israel de Alba Cruz, Carlos Arturo Cortazar Sánchez, Jorge Alejandro Domínguez Rodríguez, Jesus Fernando Nagore Ancona, and Julián Vargas Flores
- Subjects
medicine.medical_specialty ,Endoscopic retrograde cholangiopancreatography ,medicine.diagnostic_test ,business.industry ,Bile duct ,medicine.medical_treatment ,Biliary surgery ,Surgery ,03 medical and health sciences ,Bile Tract ,0302 clinical medicine ,medicine.anatomical_structure ,Biliary tract ,030220 oncology & carcinogenesis ,Concomitant ,medicine ,Stone extraction ,030211 gastroenterology & hepatology ,Cholecystectomy ,business - Abstract
Introduction There are three treatment options for choledocholithiasis: endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy; laparoscopic exploration of the main bile duct with concomitant cholecystectomy; and open cholecystectomy with exploration of the main bile duct. Material and methods A retrospective, descriptive, observational study was taken of patients with a diagnosis of cholecysto-choledocholithiasis that failed ERCP and who underwent laparoscopic cholecystectomy with exploration of the bile duct. Results From January 2009 to December 2018, 2,322 ERCP procedures were performed at Hospital Regional Ignacio Zaragoza, with a failed procedure rate of 3.2% which is equivalent to 75 patients; endoscopic sphincterotomy was performed on all 75 patients and 60 (80%) of these patients had cholelithiasis with choledocholithiasis. Open access to the bile duct through choledochotomy was required in all 75 patients, achieving successful stone extraction and bile duct clearance in 95%. Fifteen (20%) of these patients that had had laparoscopic cholecystectomy presented choledocholithiasis de novo more than two years after cholecystectomy. Nine patients underwent laparoscopic cholecystectomy and 6 patients underwent open cholecystectomy. Patients averaged 6 hospital days post-procedure. Surgical times ranged from 150 minutes to 210 minutes. Conclusion Laparoscopic reoperation of the biliary tract is a reasonable alternative for patients with a history of previous biliary surgery who have failed the ERCP approach.
- Published
- 2021
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