Management of common bile duct stones: the state of the art in 2000.
Biliary lithiasis is a widespread disease all over the world; one-third of the white population presents with stones in the biliary ducts. In Chile, it is present in 47% of adult females. The most common complications of this pathology are acute cholecystitis, choledocholithiasis, acute pancreatitis, retained common bile duct (CBD) stones, and gallbladder cancer; these constitute a serious health problem in Chile. The aim of this study was to update the information related to choledocholithiasis after 10 years of laparoscopic biliary surgery. To achieve this objective, we retrospectively analyzed the last 100 cases of choledocholithiasis admitted to the University of Chile Clinical Hospital in 2000. Prevalence by sex and age was determined. Clinical diagnosis was demonstrated to be effective in 92.3% of the cases; laboratory tests and ultrasound were effective in 81% and 90% of the cases, respectively. Diagnosis of cholelithiasis and choledocholithiasis as one unique entity corresponded to 53% of the sample; 47% of the remaining choledocholithiasis cases corresponded to retained CBD stones in patients previously cholecystectomized. Time of appearance of symptoms of this residual pathology was reviewed. All methods or procedures employed to treat this pathology were studied, and it was found that endoscopic cholangiography (ERCP) was the most frequently used procedure. Also, results of other alternative procedures, such as open surgery or ERCP combined with laparoscopic cholecystectomy, were considered. Finally, this study was complemented with a thorough bibliographic review of more than 100 publications on the subject that were published in high-impact surgical reviews, emphasizing the course of treatment followed during the last 7 years.
Fernandez
Manuel
M
Department of Surgery, Clinical Hospital, Faculty of Medicine, University of Chile, Santiago, Chile.
Csendes
Attila
A
Yarmuch
Julio
J
Diaz
Hernan
H
Silva
Jorge
J
D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D042883:Choledocholithiasis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006801:Humans