title: [Intraoperative choledochoscopy usefulness in the treatment of difficult biliary stones].
abstract: BACKGROUND
  Choledocholithiasis presents in 5-10% of the patients with biliary lithiasis. Numerous treatment algorithms have been considered for this disease, however, up to 10% of these therapeutic procedures may fail. Intraoperative choledochoscopy has become a useful tool in the treatment of patients with difficult-to-manage choledocholithiasis.
  
  
  OBJECTIVE
  To determine the usefulness of intraoperative choledochoscopy in the laparoendoscopic treatment of difficult stones that was carried out in our service.
  
  
  METHODS
  A cross-sectional study was conducted. The case records were reviewed of the patients that underwent intraoperative choledochoscopy during biliary tree exploration plus laparoscopic choledochoduodenal anastomosis within the time frame of March 1, 2011 and May 31, 2012, at the Hospital General Dr. Manuel Gea González. Transabdominal choledochoscopies were performed with active stone extraction when necessary, followed by peroral choledochoscopies through the recently formed bilioenteric anastomosis. The data were analyzed with descriptive statistics and measures of central tendency.
  
  
  RESULTS
  The mean age was 71 years, 57% of the patients were women, and the ASA III score predominated. Active extraction of stones with 7 to 35mm diameters was carried out in 4 of the cases and the absence of stones in the biliary tract was corroborated in all the patients. The mean surgery duration was 18 minutes (range: 4 to 45min).
  
  
  CONCLUSIONS
  Choledochoscopy is a safe and effective minimally invasive procedure for the definitive treatment of difficult stones.
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México. Electronic address: fitocuendis@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Cuendis-Velázquez
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: M E
authors.initials: ME
authors.lastname: Rojano-Rodríguez
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: C E
authors.initials: CE
authors.lastname: Morales-Chávez
authors.affiliation: Servicio de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: A
authors.initials: A
authors.lastname: González Angulo-Rocha
authors.affiliation: Servicio de Endoscopia Gastrointestinal, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: E
authors.initials: E
authors.lastname: Fernández-Castro
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: I
authors.initials: I
authors.lastname: Aguirre-Olmedo
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: M F
authors.initials: MF
authors.lastname: Torres-Ruiz
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: J C
authors.initials: JC
authors.lastname: Orellana-Parra
authors.affiliation: División de Cirugía General y Endoscópica, Hospital General Dr. Manuel Gea González, México D.F., México.
authors.forename: L E
authors.initials: LE
authors.lastname: Cárdenas-Lailson
mesh_terms: D001659:Biliary Tract / Q000473:pathology*; D042883:Choledocholithiasis / Q000473:pathology* / Q000601:surgery*; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods*
keywords: Cholangitis; Choledochoduodenostomy; Choledocholithiasis; Colangitis; Coledocoduodeno-anastomosis; Coledocolitiasis; Endoscopic Surgical Procedure; Procedimiento Endoscópico Quirúrgico