<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2307-0420</journal-id>
<journal-title><![CDATA[Cirugía paraguaya]]></journal-title>
<abbrev-journal-title><![CDATA[Cir. parag.]]></abbrev-journal-title>
<issn>2307-0420</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Cirugía]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2307-04202025000200018</article-id>
<article-id pub-id-type="doi">10.18004/sopaci.2025.agosto.18</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Resolución quirúrgica de la coledocolitiasis no resuelta por papilotomia endoscópica en el Instituto de Previsión Social - Ingavi, periodo 2022 - 2024]]></article-title>
<article-title xml:lang="en"><![CDATA[Surgical treatment of coledocholithiasis not resolved by endoscopic papillotomy at Instituto de Previsión Social - Ingavi, period 2022 - 2024]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Franco Chávez]]></surname>
<given-names><![CDATA[Luz Janina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Giménez]]></surname>
<given-names><![CDATA[Mara Sofía]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ovelar]]></surname>
<given-names><![CDATA[Araceli]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Zaracho]]></surname>
<given-names><![CDATA[Juan Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto de Previsión Social  ]]></institution>
<addr-line><![CDATA[Fernando de la Mora ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<volume>49</volume>
<numero>2</numero>
<fpage>18</fpage>
<lpage>20</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2307-04202025000200018&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2307-04202025000200018&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2307-04202025000200018&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Introducción: La litiasis coledociana se resuelve por colangiografía retrógrada endoscópica (CPRE) en aproximadamente el 90% de los casos; en la actualidad se describen varias opciones terapéuticas a los casos no resueltos, siendo de elección el abordaje laparoscópico. Objetivo: describir el tratamiento quirúrgico instaurado en pacientes con coledocolitiasis no resuelta por papilotomía endoscópica entre los meses de enero del 2022 a diciembre del 2024 en el Instituto de Previsión Social, Ingavi. Material y método: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Resultados: se incluyeron 56 pacientes, de los cuales el 25% eran colecistectomizados. Como causas de CPRE fallida más frecuente se encontró la desproporción entre la porción proximal y distal de la vía biliar principal en 33,9% de los casos y se constataron litos mayores a 1cm de diámetro en 30,3% de casos. 7,1% de los casos fueron resueltos por videolaparoscopía. En el abordaje convencional la coledocotomía + colocación de T de Kehr fue la de mayor frecuencia con 46,1%, seguida de la derivación biliodigestiva realizada en el 36,5% de los casos. Conclusión: el tratamiento quirúrgico de elección fue el abordaje convencional con colocación de T de Kehr.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Introduction: Common bile duct stones are resolved by endoscopic retrograde cholangiopancreatography (ERCP) in 90% of cases. Currently, several therapeutic options are described for cases that fail ERCP, with the laparoscopic surgery is often the preferred approach. Objective: To describe the surgical treatment instituted in patients with choledocholithiasis not resolved by endoscopic papillotomy between January 2022 and December 2024 at the Social Security Institute, Ingavi. Materials and methods: An observational, descriptive, retrospective, cross-sectional study. Results: A total of 56 patients were included, of whom 25% had undergone cholecystectomies. The most frequent causes of failed ERCP were disproportion between the proximal and distal portion of the main bile duct in 33.9% of cases, and stones greater than 1 cm in diameter were found in 30.3% of cases. 7.1% of the cases were resolved by videolaparoscopy. In the conventional approach, choledochotomy with T-tube placement was the most common, at 46.1%, followed by biliodigestive diversion in 36.5% of cases. Conclusion: The surgical treatment of choice was the conventional approach with Kehr's T-shaped insert.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Coledocolitiasis]]></kwd>
<kwd lng="es"><![CDATA[colangiopancreatografía retrógrada endoscópica]]></kwd>
<kwd lng="es"><![CDATA[colecistectomia]]></kwd>
<kwd lng="en"><![CDATA[Choledocholithiasis]]></kwd>
<kwd lng="en"><![CDATA[Endoscopic Retrograde Cholangiopancreatography]]></kwd>
<kwd lng="en"><![CDATA[Cholecystectomy]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ríos]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Franco-López]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Echagüe]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Experiencia en el tratamiento quirúrgico de la coledocolitiasis no resuelta por CPRE en el Hospital Nacional de Itauguá de enero a octubre de 2022]]></article-title>
<source><![CDATA[Cir Parag]]></source>
<year>2023</year>
<volume>47</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>23-7</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Barreras González]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Torres Peña]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Ruíz Torres]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Martínez Alfonso]]></surname>
<given-names><![CDATA[MÁ]]></given-names>
</name>
<name>
<surname><![CDATA[Roque González]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Brizuela Quintanilla]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Algorithm for minimally invasive treatment of the choledocholithiasis]]></article-title>
<source><![CDATA[Rev Cubana Cir]]></source>
<year>2014</year>
<volume>53</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>346-55</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="">
<source><![CDATA[Tratamiento de la colecistocoledocolitiasis: colangiografía retrógrada endoscópica preoperatoria versus transoperatoria en el Hospital Miguel Hidalgo de Aguascalientes]]></source>
<year></year>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cuadrado]]></surname>
<given-names><![CDATA[DM]]></given-names>
</name>
<name>
<surname><![CDATA[Salazar]]></surname>
<given-names><![CDATA[AF]]></given-names>
</name>
<name>
<surname><![CDATA[Orozco]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[Buitrago]]></surname>
<given-names><![CDATA[DA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Exploración por laparoscopia de la vía biliar con cierre primario en casos de colecistocoledocolitiasis en el Hospital Universitario San Ignacio]]></article-title>
<source><![CDATA[Rev Colomb Cir]]></source>
<year>2017</year>
<volume>32</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>182-5</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ortíz]]></surname>
<given-names><![CDATA[RGP]]></given-names>
</name>
<name>
<surname><![CDATA[Osorio]]></surname>
<given-names><![CDATA[AID]]></given-names>
</name>
<name>
<surname><![CDATA[Echeverri]]></surname>
<given-names><![CDATA[PG]]></given-names>
</name>
<name>
<surname><![CDATA[Parraga]]></surname>
<given-names><![CDATA[HB]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Tratamiento de la coledocolitiasis mediante CPRE e instrumentación a través de un tubo en T]]></article-title>
<source><![CDATA[Rev Colomb Gastroenterol]]></source>
<year>2020</year>
<volume>35</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>382-9</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Herrera-Ramírez M de]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
<name>
<surname><![CDATA[López-Acevedo]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez-Peña]]></surname>
<given-names><![CDATA[GA]]></given-names>
</name>
<name>
<surname><![CDATA[Mata-Quintero]]></surname>
<given-names><![CDATA[CJ]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Efficiency of laparoscopic vs endoscopic management in cholelithiasis and choledocholithiasis Is there any difference?]]></article-title>
<source><![CDATA[Cir Cir]]></source>
<year>2017</year>
<volume>85</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>306-11</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Cheng]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparison of efficacy and safety of endoscopic retrograde cholangiopancreatography in choledocholithiasis patients at different age groups a meta-analysis]]></article-title>
<source><![CDATA[Turk J Gastroenterol]]></source>
<year>2025</year>
<volume>36</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>398-407</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Díaz-Osuna]]></surname>
<given-names><![CDATA[JJ]]></given-names>
</name>
<name>
<surname><![CDATA[Leyva-Alvizo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Chávez-Pérez]]></surname>
<given-names><![CDATA[CE]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Utilidad de la colangiografía transoperatoria en pacientes con diagnóstico de coledocolitiasis con estudio de imagen o endoscópico preoperatorio]]></article-title>
<source><![CDATA[Cir Cir]]></source>
<year>2019</year>
<volume>87</volume>
<numero>2</numero>
<issue>2</issue>
</nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Harbhajan Singh]]></surname>
<given-names><![CDATA[TS]]></given-names>
</name>
<name>
<surname><![CDATA[Seang]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Roy]]></surname>
<given-names><![CDATA[SP]]></given-names>
</name>
<name>
<surname><![CDATA[Majid]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Laparoscopic choledochotomy and choledochoduodenostomy for the management of persistent common bile duct stones]]></article-title>
<source><![CDATA[SAGE Open Med Case Rep]]></source>
<year>2022</year>
<volume>10</volume>
<page-range>2050313X221128093</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hess]]></surname>
<given-names><![CDATA[GF]]></given-names>
</name>
<name>
<surname><![CDATA[Sedlaczek]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Zeindler]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Muenst]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Schmitt]]></surname>
<given-names><![CDATA[AM]]></given-names>
</name>
<name>
<surname><![CDATA[Däster]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The short- and long-term outcome after the surgical management of common bile duct stones in a tertiary referral hospital]]></article-title>
<source><![CDATA[Langenbecks Arch Surg]]></source>
<year>2023</year>
<volume>408</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>288</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Le]]></surname>
<given-names><![CDATA[LV]]></given-names>
</name>
<name>
<surname><![CDATA[Vu]]></surname>
<given-names><![CDATA[QV]]></given-names>
</name>
<name>
<surname><![CDATA[Le]]></surname>
<given-names><![CDATA[TV]]></given-names>
</name>
<name>
<surname><![CDATA[Le]]></surname>
<given-names><![CDATA[HT]]></given-names>
</name>
<name>
<surname><![CDATA[Dang]]></surname>
<given-names><![CDATA[KK]]></given-names>
</name>
<name>
<surname><![CDATA[Vu]]></surname>
<given-names><![CDATA[TN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Outcomes of laparoscopic choledochotomy using cholangioscopy via percutaneous-choledochal tube for the treatment of hepatolithiasis and choledocholithiasis a preliminary Vietnamese study]]></article-title>
<source><![CDATA[Ann Hepatobiliary Pancreat Surg]]></source>
<year>2024</year>
<volume>28</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>42-7</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<collab>Herrera-Ramírez M de los A.López-Acevedo H.Gómez-Peña GA.Mata-Quintero CJ</collab>
<article-title xml:lang=""><![CDATA[Eficiencia del manejo laparoscópico vs endoscópico en colelitiasis y coledocolitiasis. ¿Existe diferencia?]]></article-title>
<source><![CDATA[Cir Cir]]></source>
<year>2017</year>
<volume>85</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>306-11</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Estellés Vidagany]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Eleven years of primary closure of common bile duct after choledochotomy for choledocholithiasis]]></article-title>
<collab>Domingo Del Pozo C.Peris Tomás N.Díez Ares JÁ.Vázquez Tarragón A.Blanes Masson F</collab>
<source><![CDATA[Surg Endosc]]></source>
<year>2016</year>
<volume>30</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1975-82</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Liu]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Fang]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Tan]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[A comparison of the relative safety and efficacy of laparoscopic choledochotomy with primary closure and endoscopic treatment for bile duct stones in patients with cholelithiasis]]></article-title>
<source><![CDATA[J Laparoendosc Adv Surg Tech A]]></source>
<year>2020</year>
<volume>30</volume>
<numero>7</numero>
<issue>7</issue>
<page-range>742-8</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lv]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Hu]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Shi]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Wang]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Efficacy analysis of hybrid operating room-based laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography in the treatment of cholelithiasis combined with choledocholithiasis a case-control study]]></article-title>
<source><![CDATA[J Minim Access Surg]]></source>
<year>2023</year>
<volume>19</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>402</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Omar]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Redwan]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
<name>
<surname><![CDATA[Alansary]]></surname>
<given-names><![CDATA[MN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Comparative study of three common bile duct closure techniques after choledocholithotomy safety and efficacy]]></article-title>
<source><![CDATA[Langenbecks Arch Surg]]></source>
<year>2022</year>
<volume>407</volume>
<numero>5</numero>
<issue>5</issue>
<page-range>1805-15</page-range></nlm-citation>
</ref>
<ref id="B17">
<label>17</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lai]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Xu]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Feasibility and safety of choledochotomy primary closure in laparoscopic common bile duct exploration without biliary drainage a retrospective study]]></article-title>
<source><![CDATA[Sci Rep]]></source>
<year>2023</year>
<volume>13</volume>
<page-range>22473</page-range></nlm-citation>
</ref>
<ref id="B18">
<label>18</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Jan]]></surname>
<given-names><![CDATA[Y]]></given-names>
</name>
<name>
<surname><![CDATA[Hussain]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Aman]]></surname>
<given-names><![CDATA[Z]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Primary closure vs T-tube drainage following open choledochotomy for CBD (common bile duct) stones]]></article-title>
<collab>N N</collab>
<source><![CDATA[Cureus]]></source>
<year>2023</year>
<volume>15</volume>
<numero>3</numero>
<issue>3</issue>
</nlm-citation>
</ref>
<ref id="B19">
<label>19</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[He]]></surname>
<given-names><![CDATA[MY]]></given-names>
</name>
<name>
<surname><![CDATA[Zhou]]></surname>
<given-names><![CDATA[XD]]></given-names>
</name>
<name>
<surname><![CDATA[Chen]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
<name>
<surname><![CDATA[Zheng]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Zhang]]></surname>
<given-names><![CDATA[FZ]]></given-names>
</name>
<name>
<surname><![CDATA[Ren]]></surname>
<given-names><![CDATA[WW]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Various approaches of laparoscopic common bile duct exploration plus primary duct closure for choledocholithiasis a systematic review and meta-analysis]]></article-title>
<source><![CDATA[Hepatobiliary Pancreat Dis Int]]></source>
<year>2018</year>
<volume>17</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>183-91</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
