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Revista argentina de cirugía

versão impressa ISSN 2250-639Xversão On-line ISSN 2250-639X

Resumo

FERNANDEZ, Elena A.; BARRIOS ESCUBILLA, Fernando D.; RUIZ, Matías  e  MAIDANA, Romina. Complementary evaluation of complicated gallstone disease and two-stage management of choledochal lithiasis. Rev. argent. cir. [online]. 2021, vol.113, n.4, pp.427-433. ISSN 2250-639X.  http://dx.doi.org/10.25132/raac.v113.n4.1600.

Background:

Nowadays, the prevalence of gallstones ranges between 10 and 20% in Western world, and 7-16% of the patients also present choledocholithiasis. The preoperative diagnosis of choledocholithiasis is difficult.

Objective:

To establish our experience in the evaluation of complicated gallstone disease and two-stage management of choledochal lithiasis as standard or care.

Material and methods:

This prospective and observational study included patients hospitalized with gallstone disease undergoing procedures in the Department of General Surgery of Hospital Vidal from June 30, 2019, to December 30, 2019.

Results:

Ultrasound of the liver, biliary tract and pancreas was specific, with accuracy of 80.9% and sensitivity of 50%. Magnetic resonance cholangiopancreatography (MRCP) had a sensitivity of 100%, accuracy of 84.6% and sensitivity of 67%. As for endoscopic retrograde cholangiopancreatography (ERCP), the diagnosis of choledocholithiasis was made in 100% of the cases during the first cholangiography while “control” cholangiography had a sensitivity of 0%, specificity of 100% and accuracy of 15.4%. The presence of a dilated cystic duct intraoperatively in association with abnormal biochemical parameters had a sensitivity of 100%, specificity of 90%, and accuracy of 93.6%.

Conclusion:

Intraoperative cholangiography (IOC) is the gold standard procedure for the management of complicated gallstone disease. The association of biochemical parameters and a dilated cystic duct has high predictive value for choledochal lithiasis.

Palavras-chave : Choledocholithiasis; Cholangiography; Sensitivity; Specificity.

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