Current Surgical Treatment of Choledocholithiasis and use of T-tube drainage

Abstract

Choledocholithiasis has an incidence of 5-10%, 21-34% are secondary to stone migration. The incidence increases with age. The most frequent complications are biliary pancreatitis, cholangitis, or liver abscesses.¹

For the diagnosis, the conjunction of clinical symptoms, laboratory and imaging is required; ultrasound has a sensitivity of 77 to 87%. ^2,3

The treatment is surgical, previously the two-stage approach was accepted, however, currently there has been an important change in the treatment, some surgical units perform ultrasound endoscopy with sphincterotomy preoperatively when choledocholithiasis is suspected, while others combine surgical extraction of stones with laparoscopic cholecystectomy in a single surgical event. ^4,5

Another change in the current surgical treatment is the controversial use of the T-tube, since the main indication for its placement is the suspicion of a residual stone, however, this recurrence appears in a minimum percentage and the complications that derive from the placement of this are greater than its benefit, which is why a primary choledochorrhaphy is currently preferred. ^5,6

Several studies that have compared these two approaches have concluded that the approach in a single surgical event is better, since hospital time is shorter, stone extraction is more successful, and postoperative complications are less frequent. ^6,7