Cirugía en diferido de la litiasis coledociana impactada: menor porcentaje de intervención sobre la vía biliar

Abstract

The choice of immediate or delayed surgery in patients with common bile duct calculi without severity criteria is controversial. Studies of patients with common bile duct calculi show that in a considerable percentage of these patients there is spontaneous passage of these stones without the need for surgery. To compare the percentage of common bile duct stones found at surgery between patients with impacted common bile duct stones undergoing immediate and delayed surgery. Patients admitted to the Hospital de Clínicas Manuel Quintela with a diagnosis of impacted common bile duct stones were retrospectively reviewed. The patients were classified into two groups: those who underwent exploratory common bile duct surgery within 48 hours of admission (immediate surgery) and those who underwent surgery after the first 48 hours of admission (delayed surgery). The number of patients with a finding of common bile duct stones in each group was analyzed. Seventy patients (37 in the immediate surgery group and 33 in the delayed surgery group) were analyzed. Among the patients who underwent immediate surgery, 92% showed common bile duct stones on cholangiography or another instrumental procedure. In the group that underwent delayed surgery, this percentage was 64% (P< .004). Three factors predicting the absence of spontaneous passage of stones after 48 hours of admission were identified: age more than 70 years, jaundice of 7 days' duration or more and common bile duct stones visible by imaging techniques. The results of this study suggest that delayed surgery of impacted common bile duct stones reduces the number of patients requiring common bile duct surgery as well as the number of patients requiring biliary drainage. Patients aged more than 70 years old, with jaundice of more than 7 days' duration and with common bile duct stones visible by imaging techniques do not benefit from delayed surgery.