RESUMEN
Since laparoscopic cholecystectomy rapidly became the gold standard, there is an increased morbidity of 1% to 3% for clinically significant bile leaks with this procedure, as compared with open cholecystectomy (<1%). The identification of subclinical bile leaks using cholescintigraphy occurs in the range from 31.4% to 40% after elective open cholecystectomy. At this writing, no studies exist that document the rate of subclinical bile leaks after elective laparoscopic cholecystectomy. In this study, 71 patients were evaluated using cholescintigraphy after elective laparoscopic cholecystectomy. This study represents the first prospective look at the rate of subclinical bile leaks after laparoscopic cholecystectomy in elective cases, and the findings show an overall incidence of 7.3%, as compared with historical reports of 30% to 44% for open cholecystectomy.
Asunto(s)
Sistema Biliar/diagnóstico por imagen , Sistema Biliar/lesiones , Colecistectomía Laparoscópica/efectos adversos , Enfermedad Aguda , Bilis , Enfermedades de los Conductos Biliares/diagnóstico por imagen , Enfermedades de los Conductos Biliares/epidemiología , Enfermedades de los Conductos Biliares/etiología , Conductos Biliares/lesiones , Colecistitis/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Tiempo de Internación , Hígado/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Prospectivos , CintigrafíaRESUMEN
Hernias that are not correctable by primary approximation require a prosthetic material to provide a tension-free repair. We report the results of 121 consecutive ventral (40) and inguinal (81) herniorrhaphies in 112 patients using the 2.0-mm expanded polytetrafluoroethylene (ePTFE) soft tissue patch. All follow-up was conducted by physical examination by the surgical team. Average follow-up was 49 months. Five patients (4%) experienced complications: there was 1 inguinal recurrence, 1 ventral recurrence, 1 seroma, 1 wound infection, and 1 prolonged gastrocutaneous fistula. The cause of one of the recurrences is unknown because the patient refused further surgery. The seroma resolved spontaneously after two aspirations. The remaining three complications were considered to be unrelated to the implantation of the prosthetic patch. There were no complications due to adhesions, bowel erosion, or bowel obstruction in the ventral repairs. On the basis of our clinical experience, we believe that ePTFE is an acceptable mode of treatment for all difficult hernias.