Algorithm for minimally invasive treatment of the choledocholithiasis

摘要

Choledocholithiasis may be encountered at the time of laparoscopic cholecystectomy in up to 10 % of young patients and increases to over 25 % in patients aged 60 and older. Once a stone is identified in the main biliary duct, it can become a therapeutic dilemma. Definite algorithms have been established and agreed upon, but international publications continue re-defining the indications for endoscopic retrograde cholangiopancreatography over common laparoscopic bile duct exploration and vice versa. The objective of this study was to present the algorithm for treatment of choledocholithiasis in the National Center of Minimal Access Surgery in Havana. A comprehensive literature review was made on present management of choledocholithiasis with the in situ gallbladder and the results of these techniques achieved in the National Center. The management choices for choledocholithiasis include transcystic common bile duct exploration, laparoscopic common bile duct exploration via choledochotomy, and preoperative and intraoperative endoscopic retrograde cholangiopancreatography with sphincterotomy. Our algorithm for minimally invasive treatment of the choledocholithiasis was presented here. The management of this disease currently depends on the experience of the surgical team and their access to technological advances.