Manejo de la coledocolitiasis; beneficios de la cirugía laparoscópica vs CPRE. Revisión Sistemática

Abstract

Choledocholithiasis is a highly prevalent pathology in the West, representing 10 to 25% of cases. The treatment is based on the early obstruction relief of the bile ducts, employing multiple techniques such as Endoscopic Retrograde Cholangiopancreatography (ERCP) and Laparoscopic Exploration of the bile ducts. This systematic review addresses the primary characteristics of both treatments, particularly emphasizing their benefits. Objective: To determine the leading advantages and disadvantages of ERCP and laparoscopy in managing choledocholithiasis. Method: A qualitative, analytical, and descriptive systematic review was conducted based on the PRISMA 2020 guidelines. Information was gathered from virtual databases and high-impact articles published in the last five years in scientific journals like Surgical Endoscopy, Journal of Hepato-Biliary-Pancreatic Sciences, and Digestive Surgery. Results: A higher incidence of retained stones was observed in patients undergoing the endoscopic technique. Bile leakage predominantly occurred in the laparoscopic technique. The development of pancreatitis was more common in patients experiencing ERCP. Bleeding was higher in patients undergoing laparoscopic intervention. Conclusions: Both procedures are acceptable and recommended in the surgical setting, but the endoscopic technique is currently the method of choice. The laparoscopic technique offers multiple benefits; however, in our environment, untrained personnel and necessary instruments constitute a bias that hinders the adoption of the technique as a first-line treatment.