Colangiografía transcística transoperatoria como abordaje inicial en sospecha de coledocolitiasis

Abstract

RESUMEN: INTRODUCCIÓN: La coledocolitiasis representa del 8% al 20% de los pacientes con colelitiasis. Se han identificado diferentes factores de riesgo relacionados con coledocolitiasis, sin embargo, el diagnóstico y tratamiento ideal son controversiales. La colangiografía transcística alcanza una especificidad del 93% y sensibilidad del 100% para diagnosticar coledocolitiasis. Estudios anteriores sugieren que el tratamiento endoscópico con colecistectomía laparoscópica es potencialmente riesgoso y puede ser evitada con colangiografía rutinaria durante la colecistectomía. OBJETIVO: Determinar si el uso de colangiografía transcística transoperatoria en pacientes con sospecha de coledocolitiasis es un estudio eficaz para el diagnóstico de la patología, disminuyendo la necesidad de estudios posteriores. MATERIAL Y MÉTODOS: Estudio piloto, descriptivo, prospectivo y transversal. Se incluyeron pacientes con sospecha de coledocolitiasis que aceptaran el procedimiento durante la colecistectomía. Se desarrolló un diagrama terapéutico a partir de la realización de una colangiografía transcística transoperatoria. RESULTADOS: Se operaron a 13 mujeres (edad media: 29.2 ± 12.2 años) en hospitales del estado de Aguascalientes. Basados en los criterios ASGE 2010, 61.5% tuvieron riesgo alto, de las cuales 38.5% presentaron litos en la vía biliar principal. El 38.5% tuvieron riesgo intermedio, sin embargo, sólo en el 23.1% se identificaron litos. CONCLUSIÓN: La coledocolitiasis representa un reto para el tratamiento adecuado. Los resultados de este estudio sugieren que la colangiografía trancística intraoperatoria durante la colecistectomía laparoscópica es un método válido para el diagnóstico de coledocolitiasis, en pacientes con categoría de riesgo alto e intermedio, permitiendo la resolución de la patología durante un solo evento quirúrgico. Palabras clave: colangiografía, coledocolitiasis.

ABSTRACT: BACKGROUND: Patients with cholelitiasis have 8-12% chance of developing choledocolitiasis. This is the second most common complication. Different risk factors have been identified, however, ideal diagnosis and treatment remains controversial. Transcystic cholangiography is a suitable technique with high specificity and sensitivity for the diagnosis of choledocolitiasis. Previous studies suggest that the use of this technique during laparoscopic cholecistectomy can improve diagnosis of common bile duct calculous. OBJECTIVE: To assess if transcystic cholangiography during cholecistectomy improves makes a diagnosis of choledocolitiasis and reduces further diagnostic maneuvers. METHODS: This is a pilot, descriptive, prospective and cross-sectional study. Patients were included if they had acute cholecystitis with clinical suspicion of choledocolitiasis. All patients signed informed consent. We developed a therapeutic algorithm for the use of intraoperative transcystic cholangiography. RESULTS: Thirteen women were submited to cholecistectomy (average age: 29.2 ± 12.2 years) at four second and third level hospitals in Aguascalientes, Mexico. Based on ASGE 2010 criteria, 61.5% patients had high risk for choledocolithiasis, of which 38.5% had calculous in the distal common bile duct. Intermediate risk (38.5%), only 23.1% had calculous, many of them had other risk factors. CONCLUSION: Currently, choledocolitiasis represents a treatment challenge for the general surgeon. Results in this study suggest that the use of intraoperative transcystic cholangiography during laparoscopic cholecistectomy is a valid method for the proper diagnosis of choledocolithiasis, especially in those patients with high and intermediate risk, and its use allows resolution of the pathology in one surgical event. Key Words: cholangiografy, choledocolithiasis