SURGICAL AND ENDOSCOPIC MANAGEMENT IN THE TREATMENT OF CHOLEDOCHOLITHIASIS

Abstract

Choledocholithiasis is one of the main complications of cholelithiasis, responsible for significant morbidity, such as cholangitis and acute biliary pancreatitis. With the evolution of minimally invasive techniques, the treatment of this condition has integrated endoscopic and surgical approaches, expanding therapeutic possibilities and favoring better clinical outcomes. This study aimed to review recent scientific evidence regarding the surgical and endoscopic management of choledocholithiasis. This is a narrative literature review conducted through a search in the PubMed database, using the descriptors "Choledocholithiasis" and "Therapeutics", combined with the Boolean operators AND and OR. Contemporary publications were prioritized, but classic articles considered fundamental for the discussion of the techniques addressed were also included, in Portuguese and English, with direct relevance to the topic. It was observed that the definition of the therapeutic strategy depends on adequate risk stratification, based on clinical, laboratory, and imaging criteria. Endoscopic Retrograde Cholangiopancreatography (ERCP) remains widely used, mainly in sequential approaches associated with laparoscopic cholecystectomy. However, single-stage surgical techniques, such as laparoscopic exploration of the common bile duct and the Rendezvous technique, have shown promising results, including high effectiveness in stone removal, shorter hospital stays, and a lower incidence of some complications related to conventional ERCP in specialized centers. Despite therapeutic advances, the choice of the ideal approach remains dependent on the team's experience, the available infrastructure, and the patient's clinical condition. Therefore, it is concluded that the management of choledocholithiasis should be individualized and multidisciplinary, prioritizing safety, effectiveness, and reduced morbidity.