ABSTRACT
BACKGROUND: Current evidence shows that single-stage treatment of concomitant choledocholithiasis and cholelithiasis is as effective and safe as two-stage treatment. However, several studies suggest that single-stage approach requires shorter hospitalization time and is more cost-effective than the two-stage approach, even though it requires considerable training. This study aimed to evaluate the implementation of a protocol for managing concomitant choledocholithiasis and cholelithiasis using single-stage treatment. METHODS: A prospective cohort study of patients diagnosed with cholelithiasis and choledocholithiasis who were treated with the single-stage treatment - transcystic instrumentation, choledocotomy or intraoperative endoscopic retrograde cholangiopancreatography (ERCP) - between September 2010 and June 2017 was assessed. The primary outcomes were complications, hospital stay, operative time and recurrence rate. RESULTS: 164 patients were enrolled. 141 (86%) were operated laparoscopically. Preoperatively diagnosed stones were not found by intraoperative imaging or disappeared after "flushing" in 38 patients (23.2%). Surgical approach was transcystic in 45 patients (27.41%), choledochotomy in 74 (45.1%), intraoperative ERCP in 4 (2.4%), and bilioenteric derivation in 3 (1.8%). Mean hospitalization stay was 4.4 days. Mean operative time was 166 min 27 patients (16.5%) had complications and 1 patient was exitus (0.6%). Recurrence rate was 1.2%. CONCLUSIONS: Single-stage approach is a safe and effective management option for concomitant cholelithiasis and choledocolithiasis. Furthermore, a significant number of common bile duct stones pass spontaneously to duodenum or can benefit from a transcystic approach, with presumable low morbidity and cost-efficiency.
Subject(s)
Biliary Tract Surgical Procedures/methods , Choledocholithiasis/complications , Choledocholithiasis/surgery , Adult , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis/diagnosis , Clinical Protocols , Female , Humans , Length of Stay , Male , Middle Aged , Operative Time , Patient Selection , Prospective Studies , Treatment Outcome , Young AdultSubject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Hematologic Diseases/therapy , Splenectomy/statistics & numerical data , Adrenal Cortex Hormones/therapeutic use , Antineoplastic Agents/therapeutic use , Hypersplenism/therapy , Porphyrias/therapy , Postoperative Care , Postoperative Complications , Primary Myelofibrosis/therapy , Purpura, Thrombocytopenic/therapy , Spherocytosis, Hereditary/therapy , Splenectomy , Splenomegaly/therapy , Thrombocytosis/drug therapySubject(s)
Child , Adolescent , Adult , Middle Aged , Aged , Humans , Male , Female , Hematologic Diseases/therapy , Splenectomy/statistics & numerical data , Splenectomy/methods , Postoperative Complications , Purpura, Thrombocytopenic/therapy , Hypersplenism/therapy , Splenomegaly/therapy , Postoperative Care , Thrombocytosis/drug therapy , Spherocytosis, Hereditary/therapy , Adrenal Cortex Hormones/therapeutic use , Antineoplastic Agents/therapeutic use , Porphyrias/therapy , Primary Myelofibrosis/therapyABSTRACT
Se presenta el primer caso de la bibliografia nacional y segundo de la bibliografía mundial de leiomioma del colédoco. Se trata de un hallazgo fortuito en una mujer de 69 años de edad quien presentaba un síndrome coledociano a 40 años de una colecistectomía; la resección submucosa del tumor permitió la curación
Subject(s)
Humans , Aged , Female , Bile Duct Neoplasms/surgery , Common Bile Duct/surgery , Leiomyoma/surgeryABSTRACT
Se presenta el primer caso de la bibliografia nacional y segundo de la bibliografía mundial de leiomioma del colédoco. Se trata de un hallazgo fortuito en una mujer de 69 años de edad quien presentaba un síndrome coledociano a 40 años de una colecistectomía; la resección submucosa del tumor permitió la curación (AU)
