WHAT IS THE IDEAL NUMBER OF PROCEDURES TO RESOLVE CHOLEDOCHOLITHIASIS? dr.daniel.saga@outlook.com

 

WHAT IS THE IDEAL NUMBER OF PROCEDURES TO RESOLVE CHOLEDOCHOLITHIASIS?

3

Mexico

Oral or Poster

Choledocholithiasis is a common complication of cholelithiasis, whose mangament remains a subject of debate, specially when discussing the optimal number of procedures required for a definitive resolution. The tendency towards minimally invasive techniques has favoured ERCP and laparoscopic cholecystectomy, however, in complicated or refractory cases these strategies may prove insufficient.

We will present six clinical cases of choledocolithiasis that were initially treated with non-resolving procedures (ERCP, prosthesis placement, surgical drainage) that eventually requiered an open bile duct exploration suergery for a definitive resolution. The number of procedures per case ranged between three and nine.

In all six cases, choledocholithiasis was only resolved after an open bile duct exploration surgery, following multiple endoscopic failled attempts.We found that prolonged hospital stays increased complications (bilomas, fistules, pseudocysts) and a higher care burden.

An adequate evaluation should guide the selection of the most appropriate management strategy for choledocholithiasis, in order to avoid multiple non-definitive procedures. Choosing the optimal therapeutic approach reduces the risk of complications, minimizes the number of interventions and hospital stay, and improves cost-effectiveness. Open surgery remains a relevant option in the management of choledocholithiasis; therefore, its study and continued teaching in academic centers is essential for the development of fundamental skills and competencies that enable tailored case resolution based on standardized criteria, ultimately ensuring the delivery of definitive treatment.