title: [Laparoscopic choledochoduodenostomy as an optional treatment choledocholithiasis].
abstract: BACKGROUND
  Choledochoduodenostomy is indicated for unsolved choledocholithiasis and biliary malignant or benign stenosis. This surgical procedure has been feared for its potential complications. This article shows our initial experience with this laparo-endoscopic approach.
  
  
  METHODS
  We performed laparoscopic choledochoduodenoastomy in seven elderly patients with recurrent or unsolved choledocholithiasis. Additionally, laparo-endoscopic extraction of gallstones was performed in necessary cases. We gathered and analyzed the demographic data, diagnostic proofs and follow up of the patients.
  
  
  RESULTS
  Average age of patients was 71 years, with 57.1% of women in our population. Main omorbidities of our patients included obesity in 71.4%, diabetes mellitus type 2 in 57.4%, and arterial hypertension in 42.85%. Patients had in average 2.7 previous episodes of choledocholithiasis and/or cholangitis and the average diameter of the removed stones was 22.6 mm. Average follow-up was 155 days (range 28 to 420).
  
  
  CONCLUSIONS
  Laparoscopic chooledochoduodenostomy has proved to be safe, effective and be superior to open surgery, as long as an appropriate selection of patients is performed and surgeons with experience on laparoscopic techniques are available. All these factors reduce the long-term complications with which this surgical procedure has been related.
  
  
  CONCLUSIONS
  Laparoscopic choledochoduodenostomy is an option for the definitive surgical treatment of "difficult choledocholithiasis" in elderly patients with multiple comorbidities; it also offers the advantages of the minimally invasive approaches.
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General "Dr. Manuel Gea González." Tlalpan, D.F., México. fitocuendis@hotmail.com
authors.forename: Itzé
authors.initials: I
authors.lastname: Aguirre-Olmedo
authors.forename: Adolfo
authors.initials: A
authors.lastname: Cuendis-Velázquez
authors.forename: Carlos Ernesto
authors.initials: CE
authors.lastname: Morales-Chávez
authors.forename: María Fernanda
authors.initials: MF
authors.lastname: Torres-Ruiz
authors.forename: Martín Edgardo
authors.initials: ME
authors.lastname: Rojano-Rodríguez
authors.forename: Luis Eduardo
authors.initials: LE
authors.lastname: Cárdenas-Lailson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002768:Choledochostomy / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies
keywords: Laparoscopic choledochoduodenostomy; cholangitis; complex choledocholithiasis