Choledochal Lithiasis. Multidisciplinary Therapeutic Target. Past and Present.

Area of Science:

• Gastroenterology
• Surgical Innovation
• Biliary Tract Diseases

Background:

• Cholelithiasis is a common surgical pathology.
• Treatment for choledochal lithiasis (CL) has evolved significantly over 50 years.
• Historically, surgery was the sole treatment for CL.

Purpose of the Study:

• To review the evolution of choledochal lithiasis treatment over 50 years.
• To compare outcomes of classical surgery versus a multidisciplinary approach.
• To propose a classification for therapeutic indications in CL.

Main Methods:

• Retrospective study of 1329 patients with choledocholithiasis.
• Group 1 (1959-1997): 982 patients treated with classical surgery.
• Group 2 (1997-2017): 347 patients treated with endoscopic and/or classical surgery.

Main Results:

• In Group 2, 76.6% of patients underwent endoscopic surgery, compared to 23.4% with classical surgery.
• Endoscopic failure rate was 26.3% in Group 2.
• Classical surgery had a 12.3% failure rate for obstruction clearance, often requiring biliodigestive anastomoses.

Conclusions:

• A multidisciplinary approach integrating endoscopy and surgery is now standard for CL.
• Proposed therapeutic indications categorize CL into "endoscopic choledochus," "surgical choledochus," and "lithogenic choledochus."
• Complex, complicated, or relapsing CL (categories 2 and 3) may be contraindicated for endoscopic clearance.