RESUMEN
Liver function tests help in the follow-up of postoperative patients with iatrogenic bile duct injury. There is not clear evidence regarding their predictive role on anastomosis dysfunction. We describe our experience with postoperative liver function tests and a predictive model of long-term patency after repair. This is retrospective cohort study of patients with bilioenteric anastomosis for bile duct injury and their long-term follow-up. A binomial logistic regression model was performed to ascertain the effects of the grade of bile duct injury and liver function test in the postoperative period. A total of 329 patients were considered for the analysis. In the logistic regression model two predictor variables were statistically significant for anastomosis stenosis: type of bilioenteric anastomosis and alkaline phosphatase levels. A ROC curve analysis was made for alkaline phosphatase with an area under the curve of 0.758 (95% CI 0.67-0.84). A threshold of 323 mg/dL was established (OR 6.0, 95% CI 2.60-13.83) with a sensitivity of 75%, specificity of 67%, PPV of 20%, NPV of 96%, PLR of 2.27 and NLR of 0.37. Increased alkaline phosphatase (above 323 mg/dL) after the fourth operative week was found to be a predictor of long-term dysfunction.
Asunto(s)
Fosfatasa Alcalina , Enfermedades de los Conductos Biliares , Anastomosis Quirúrgica/efectos adversos , Enfermedades de los Conductos Biliares/cirugía , Conductos Biliares/lesiones , Conductos Biliares/cirugía , Humanos , Pruebas de Función Hepática , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Periodo Posoperatorio , Estudios RetrospectivosAsunto(s)
Humanos , Enfermedades de las Vías Biliares/cirugía , Enfermedades de las Vías Biliares/complicaciones , Hígado/cirugía , Colecistectomía Laparoscópica , Conductos Biliares/cirugía , Enfermedades de los Conductos Biliares/cirugía , Complicaciones Intraoperatorias , Complicaciones PosoperatoriasRESUMEN
OBJECTIVE: To evaluate the usefulness of retrograde cholangiography performed with simple balloon-assisted enteroscopy for the management of bile duct pathology in patients with altered anatomy by surgery at the Anglo American Clinic. MATERIALS AND METHODS: This is a retrospective descriptive study where all patients with altered anatomy who came for bile duct problems to undergo a retrograde cholangiography assisted by simple balloon enteroscopy at the Anglo American Clinic during the January period from 2014 to January 2020. RESULTS: We performed 10 studies of retrograde cholangiography assisted by simple balloon enteroscopy. Cannulation of the bile duct was successful in 80% of our cases, in two cases the bile duct could not be located. The findings of the retrograde cholangiography were biliary stones in 7 cases, stenosis of the biliodigestive anastomosis in 5 cases, and an ampuloma. The most frequent therapeutic procedures were CRE progressive balloon dilation of the bilioenteric anastomosis and extraction of stones with a Dormia basket. There were no complications associated with the procedure. CONCLUSION: Retrograde cholangiography assisted by simple balloon enteroscopy is a safe and effective method to resolve biliary pathology in our patients with altered anatomy.
Asunto(s)
Enteroscopia de Balón , Enfermedades de los Conductos Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
RESUMEN Objetivo : Evaluar la utilidad de la colangiografía retrógrada realizada con enteroscopia asistida por balón simple para el manejo de la patología de la via biliar en pacientes con anatomía alterada por cirugía en la Clínica Anglo Americana. Materiales y métodos : El presente es un estudio descriptivo retrospectivo donde se evalúan a todos los pacientes con anatomía alterada que acudieron por problemas de la via biliar para realizarse una colangiografía retrógrada asistida por enteroscopia con balón simple en la Clínica Anglo Americana durante el periodo de enero del 2014 a enero del 2020. Resultados : Realizamos 10 estudios de colangiografía retrógrada asistida por enteroscopia con balón simple. La canulación de la vía biliar fue exitosa en el 80% de nuestros casos, en dos casos no se pudo localizar la via biliar. Los hallazgos de la colangiografía retrógrada fueron litiasis de via biliar en 7 casos, estenosis de la anastomosis biliodigestiva en 5 casos y un ampuloma. Los procedimientos terapeúticos más frecuentes fueron dilatación con balón progresivo CRE de la anastomosis bilioentérica y extracción de litos con canastilla de Dormia. No se presentaron complicaciones asociadas al procedimiento. Conclusión : La colangiografía retrógrada asistida por enteroscopia con balón simple es un método seguro y eficaz para resolver la patología biliar en nuestros pacientes con anatomía alterada.
ABSTRACT Objective : To evaluate the usefulness of retrograde cholangiography performed with simple balloon-assisted enteroscopy for the management of bile duct pathology in patients with altered anatomy by surgery at the Anglo American Clinic. Materials and methods : This is a retrospective descriptive study where all patients with altered anatomy who came for bile duct problems to undergo a retrograde cholangiography assisted by simple balloon enteroscopy at the Anglo American Clinic during the January period from 2014 to January 2020. Results : We performed 10 studies of retrograde cholangiography assisted by simple balloon enteroscopy. Cannulation of the bile duct was successful in 80% of our cases, in two cases the bile duct could not be located. The findings of the retrograde cholangiography were biliary stones in 7 cases, stenosis of the biliodigestive anastomosis in 5 cases, and an ampuloma. The most frequent therapeutic procedures were CRE progressive balloon dilation of the bilioenteric anastomosis and extraction of stones with a Dormia basket. There were no complications associated with the procedure. Conclusion : Retrograde cholangiography assisted by simple balloon enteroscopy is a safe and effective method to resolve biliary pathology in our patients with altered anatomy.
Asunto(s)
Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de los Conductos Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Enteroscopia de Balón , Estudios Retrospectivos , Centros de Atención TerciariaRESUMEN
BACKGROUND: Bile duct injuries after cholecystectomy remain a major concern because their incidence has not changed through the years despite technical advances. This video presents a robotic left hepatectomy and Roux-en-Y hepaticojejunostomy as a treatment for a complex bile duct injury after laparoscopic cholecystectomy. METHODS: A 52-year-old man underwent laparoscopic cholecystectomy at another institution 8 years previously, which resulted in a bile duct injury. His postoperative period was complicated by jaundice and cholangitis. He was treated with endoscopic retrograde cholangiopancreatography and multiple endoprostheses for 3 years, after which the endoprostheses were removed, and he was sent to the authors' institution. Computed tomography showed that the left liver had signs of disturbed perfusion and dilation of the left intrahepatic bile duct. The patient was asymptomatic and refused any further attempt at surgical correction of the lesion. He was accompanied for 5 years. Magnetic resonance imaging showed progressive atrophy of the left liver. Finally, 3 months before this writing, he presented with intermittent episodes of cholangitis. A multidisciplinary team decided to perform left hepatectomy with Roux-en-Y hepatojejunostomy via a robotic approach. The left liver was atrophied, and left hepatectomy was performed. Fluorescence imaging was used to identify the right bile duct. At opening of the right bile duct, small stones were found and removed. Antecolic Roux-en-Y hepaticojejunostomy then was performed. RESULTS: The operative time was 335 min. Recovery was uneventful, and the patient was discharged on postoperative day 4. CONCLUSIONS: Robotic repair of bile duct injuries is feasible and safe, even when liver resection is necessary. This video may help oncologic surgeons to perform this complex procedure.
Asunto(s)
Anastomosis en-Y de Roux/métodos , Enfermedades de los Conductos Biliares/cirugía , Conductos Biliares/cirugía , Colecistectomía Laparoscópica/efectos adversos , Hepatectomía/métodos , Yeyunostomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Enfermedades de los Conductos Biliares/etiología , Conductos Biliares/lesiones , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Grabación en VideoRESUMEN
BACKGROUND: There are only a few reports regarding the quality of life of patients who underwent a complicated cholecystectomy with an iatrogenic bile duct injury (IBDI); the results have been heterogeneous and realized with unspecific measures. METHODS: The objective was to determine whether the quality of life of the subjects with a history of IBDI repaired with bilioenteric derivation is modified in the long term with respect to a control group, for which a group of patients with a history of IBDI (group A) was compared with a group of patients with a history of uncomplicated cholecystectomy (group B). Two different measures were used: on the one hand, the SF-12 questionnaire and on the other hand, a questionnaire was implemented where the patient could determine by himself which variables define his quality of life. RESULTS: A total of 46 patients were included in group A and 51 in group B. The analysis of the SF-12 questionnaire showed a statistical significant reduction in 4 of 8 of the evaluated parameters (general health, physical functioning, physical role and social functioning) in group A in comparison with group B. If a more specific questionnaire is used, the results are similar, with a statistically significant reduction in the quality of life within the group A (0.03). CONCLUSIONS: We conclude that the quality of life of patients with a history of bilioenteric derivation due to an IBDI decreases significantly compared to patients with uncomplicated cholecystectomy.
Asunto(s)
Conductos Biliares/lesiones , Colecistectomía/efectos adversos , Laceraciones/etiología , Calidad de Vida , Adolescente , Adulto , Anciano , Enfermedades de los Conductos Biliares/cirugía , Conductos Biliares/cirugía , Femenino , Humanos , Enfermedad Iatrogénica , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores de Tiempo , Adulto JovenAsunto(s)
Enfermedades de los Conductos Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica , Pancreatocolangiografía por Resonancia Magnética/métodos , Remoción de Dispositivos/efectos adversos , Hipertensión Portal , Hemorragia Posoperatoria , Implantación de Prótesis , Stents Metálicos Autoexpandibles , Adulto , Enfermedades de los Conductos Biliares/diagnóstico , Enfermedades de los Conductos Biliares/etiología , Enfermedades de los Conductos Biliares/fisiopatología , Pérdida de Sangre Quirúrgica , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Remoción de Dispositivos/métodos , Femenino , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/etiología , Masculino , Persona de Mediana Edad , Cuidados Paliativos/métodos , Hemorragia Posoperatoria/diagnóstico , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/cirugía , Implantación de Prótesis/instrumentación , Implantación de Prótesis/métodosRESUMEN
Objetivo Presentar la experiencia sobre la utilidad de la colangiopancreatografía retrógrada endoscópica (CPRE) en el manejo pre- y postoperatorio de pacientes con hidatidosis hepática complicada. Material y método Serie de casos de carácter retrospectivo de 14 pacientes sometidos a CPRE en el Servicio de Cirugía y Endoscopía del Hospital Regional de Coyhaique, desde enero de 2005 a diciembre de 2014. En esta presentación se separan a los pacientes en los cuales la CPRE fue utilizada como diagnóstico de aquellos en los que se utilizó como manejo de la fístula biliar externa. Los pacientes después del alta fueron controlados al mes, 3, 6 meses, para posteriormente realizarlo anualmente. Resultados Hubo 5 pacientes sometidos a CPRE en el preoperatorio. El motivo de consulta fue ictericia y dolor. En todos se encontraron membranas hidatídicas las cuales fueron extraídas. Se realizó esfinterotomía en todos ellos y en solo uno se dejó endoprótesis. Cuatro pacientes fueron estabilizados y operados de manera programada y solo uno no requirió de intervención. En los 9 pacientes con fístula biliar externa, débito > 200 ml, se realizó CPRE en el postoperatorio. El tamaño promedio del quiste fue de 12 cm y 2/3 de ellos eran multivesiculares. La técnica realizada fue quistectomía parcial y en 4/9 se llevó a cabo mediante videolaparoscopía. La indicación de la CPRE se efectúo a los 20 días y el débito promedio fue de 498 ml/día. En todos se realizó esfinterotomía con instalación de endoprótesis. El cierre de la fístula biliar externa aconteció a los 28 días. El seguimiento promedio alcanzó los 6 años y no existió mortalidad en la presente serie. Conclusión Este estudio confirma que la CPRE es un procedimiento útil y seguro en el diagnóstico y tratamiento de las complicaciones biliares de la hidatidosis hepática.
Aim To report the experience with endoscopic colangiopancreatography (ERCP) in the pre and postoperative management of complicated liver hydatidosis. Material and methods Case series retrospective of 14 patients who underwent ERCP in the Department of Surgery and Endoscopy Regional Hospital of Coyhaique, from January 2005 to December 2014. In this presentation, patients are separated in whom ERCP was used as diagnosis of those in which was used as handling external biliary fistula. Patients after discharge were monitored per month, 3, 6 months later to realize it annually Results Five patients consulting for jaundice and pain were subjected to ERCP in the preoperative period. Hydatid membranes were found and extracted in all. A sphincterotomy was performed in all and an endoprosthesis was placed in one. Four patients were operated posteriorly and only one did not require surgery. On 9 patients with an external biliary fistula draining more than 200 ml/day, a postoperative ERCP was carried out. The mean sized of the cyst was 12 cm and two thirds were multi-vesicular. The surgical procedure was a partial cystectomy and in four it was laparoscopic. The mean output of fistulae was 498 ml/day. The ERCP was carried out in the twentieth postoperative day, performing a sphincterotomy and placing an endoprosthesis in all. Fistulae closed at 28 days. Patients were followed for six years and none died. Conclusions ERCP is safe and useful for the diagnosis and management of biliary complications of liver hydatidosis.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Fístula Biliar/cirugía , Fístula Biliar/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica/métodos , Equinococosis Hepática/complicaciones , Enfermedades de los Conductos Biliares/cirugía , Enfermedades de los Conductos Biliares/diagnóstico por imagen , Estudios Retrospectivos , Estudios de Seguimiento , Fístula Biliar/etiología , Resultado del Tratamiento , Equinococosis Pulmonar/cirugíaRESUMEN
INTRODUCTION: Predicting the clinical course of primary sclerosing cholangitis (PSC) is difficult. There are currently a paucity of studies evaluating serum chemistries as predictors of conventional clinical endpoints. The purpose of this study was to prognosticate key clinical endpoints in patients with PSC who had elevated serum liver chemistries at the time of their initial presentation. METHODS: We performed a retrospective cohort study of PSC patients at our institution. The aim of our study was to determine the association between elevated liver chemistries at initial presentation-bilirubin, alanine transaminase, aspartate transaminase, or alkaline phosphatase-with a primary outcome of either cholangiocarcinoma, liver transplantation, death, or composite of the 3. The secondary endpoints examined were development of severe biliary ductal disease and need for biliary stent placement. RESULTS: Eighty-one PSC patients (61 males and 20 females) were included in this study. By univariate analysis, there was a significant association between initial bilirubin elevation >2x the upper limit of normal (ULN) and death (P<0.009). Multivariate regression analysis revealed that an elevated initial serum total bilirubin >2xULN (P<0.017) significantly predicted the composite endpoint. By univariate analysis of pre-endoscopic retrograde cholangiopancreatography labs, serum bilirubin level elevation >2xULN showed an association with severity of biliary ductal disease (P<0.0001). A logistic regression of outcome variables also proved that >2xULN serum bilirubin levels predicted the ductal disease severity (P<0.0001). CONCLUSIONS: An initial elevation of serum total bilirubin >2xULN in PSC patients correlates positively with the development of cholangiocarcinoma, subsequent liver transplantation, and death. Elevated bilirubin also correlates positively with the severity of cholangiographic findings.
Asunto(s)
Neoplasias de los Conductos Biliares/sangre , Bilirrubina/sangre , Colangiocarcinoma/sangre , Colangitis Esclerosante/sangre , Adulto , Anciano , Enfermedades de los Conductos Biliares/epidemiología , Enfermedades de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/epidemiología , Colangiocarcinoma/epidemiología , Colangiopancreatografia Retrógrada Endoscópica , Colangitis Esclerosante/epidemiología , Estudios de Cohortes , Femenino , Humanos , Trasplante de Hígado/estadística & datos numéricos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Análisis de Regresión , Estudios Retrospectivos , StentsRESUMEN
CONTEXT: Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology. METHODS: We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention. RESULTS: Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation. CONCLUSION: The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies.
Asunto(s)
Enfermedades de los Conductos Biliares/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Endoscopía del Sistema Digestivo/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Quality of life after bile duct injury is a relevant health issue besides physician-oriented outcomes. A prospective study was performed to explore short- and long-term outcomes after surgical repair. METHOD: We studied a cohort of patients with Strasberg E injuries who underwent Roux-en-Y jejunal anastomosis from 1990 to 2008. The Short Form Health Survey (SF-36) was selected as the appropriate quality of life assessment instrument. Two groups were comprised: Group I included patients with 10-year follow-up after surgery. Group II included patients operated during 2008 with preoperative 1- and 5-year questionnaires. RESULTS: Group I patients (N = 41) were operated from 1990 to 2003 and Group II (N = 44) during 2008. There is a significant improvement in quality of life after the first year of repair in all domains. Readmissions (48 vs 25 %; p < 0.01), colangitis (46 vs 14 %; p < 0.001), and hepatojejunal redo (26 vs. 4 %; p < 0.0001) were less frequent in Group II. No differences in quality of life summary scores were found between Group I and II. CONCLUSIONS: Quality of life improves significantly after the first year of surgical repair, reaching a plateau at 5 years. No correlation exists with physician-centered outcomes.
Asunto(s)
Enfermedades de los Conductos Biliares/cirugía , Conductos Biliares/lesiones , Colecistectomía Laparoscópica/efectos adversos , Predicción , Complicaciones Posoperatorias/psicología , Calidad de Vida , Adulto , Anastomosis Quirúrgica/métodos , Enfermedades de los Conductos Biliares/epidemiología , Enfermedades de los Conductos Biliares/psicología , Conductos Biliares/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Periodo Posoperatorio , Pronóstico , Estudios Prospectivos , Reoperación , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
Context Direct endoscopic visualization of biliopancreatic duct is certainly one of the greatest advances of therapeutic endoscopy. The use of a single-operator cholangioscopy platform (SpyGlass) is a promising technique in the evaluation of diseases such as indeterminate biliary stricture and giant choledocholitiasis. This is the first Brazilian case series using this technology. Methods We report a case series of 20 patients in whom SpyGlass was used with diagnostic and therapeutic intention. Results Most patients were female (60%) and the median age was 48 years (ranging from 14 to 94). Choledocholitiasis was the most common indication (12/20), and electrohydraulic lithotripsy was applied in eight (66%). Electrohydraulic lithotripsy was successful in seven (87.5%) patients. Partial stone fragmentation occurred in one patient with large stone causing stone-choledochal disproportion, which was conducted with biliary plastic stent placement and a second scheduled endoscopic approach in 3 months. In cases of undefined etiology of biliary strictures, it was possible to exclude malignancy due to direct visualization (7/8) or biopsy (1/8). One complication occurred (duodenal perforation) after papillary balloon dilation. Conclusion The use of SpyGlass demonstrated the benefits, especially in cases of large bile duct stones and indeterminate biliary strictures. Other potencial improvements such as reduction on radiation exposure should be confirmed in prospective studies. .
Contexto A visão endoscópica direta das vias biliopancreáticas é certamente um dos maiores avanços na endoscopia terapêutica. O uso da plataforma de colangioscopia de operador-único (SpyGlass) é uma técnica promissora na avaliação de afecções tais como estenoses de etiologia indefinida e coledocolitíase gigante. Essa é a primeira série de casos brasileira utilizando o método. Métodos Reportamos uma série de casos de 20 pacientes nos quais foi realizado Spyglass com objetivos diagnósticos e terapêuticos. Resultados A maioria dos pacientes era do sexo feminino (60%), com idade que variou de 14 a 94 anos (mediana de 48). Coledocolitíase foi a indicação mais comum (12/20) e litotripsia eletrohidráulica foi realizada em oito (66%). Litotripsia eletrohidráulica foi realizada com sucesso em sete (87,5%) pacientes. Fragmentação parcial dos cálculos ocorreu em um paciente com desproporção cálculo-coledociana, sendo conduzido com colocação de prótese plástica e reabordagem endoscópica programada em 3 meses. Nos casos de estenoses biliares de etiologia indeterminada, foi possível a exclusão de malignidade devido a visualização direta (7/8) ou biópsia (1/8). Uma complicação ocorreu (perfuração duodenal) após dilatação balonada da papila. Conclusão Foram demonstrados os benefícios do uso do Spyglass, principalmente nos casos de coledocolitíase gigante e estenoses biliares de etiologia indefinida. Outras potenciais vantagens como a redução da exposição à radiação deve ser confirmada em estudos prospectivos posteriores. .
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Enfermedades de los Conductos Biliares/cirugía , Endoscopía del Sistema Digestivo/métodos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION AND AIM: Endoscopic treatment is the best option for patients with postsurgical stricture of main biliary duct. There is scarce information about the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) complications in this condition. The aim was to evaluate the incidence of complications and the associated risk factors in patients undergoing ERCP for postcholecystectomy biliary stricture. MATERIALS AND METHODS: Prospective analysis of patients with postsurgical stenosis of main biliary duct was carried out. Rate of post-ERCP complications was determined and the associated risk factors were analyzed. RESULTS: A total of 25 patients were included. The success rate of endoscopic treatment was 92% (n=23). Two patients had recurrence of stricture with median follow-up of 23 months (range, 0.3 to 65.4 mo). Five patients (20%) developed acute pancreatitis after ERCP. No risk factors were detected in multivariate analysis. CONCLUSION: Incidence of post-ERCP pancreatitis is high in patients with biliary stricture associated with surgical procedures.
Asunto(s)
Enfermedades de los Conductos Biliares/patología , Enfermedades de los Conductos Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Pancreatitis/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Constricción Patológica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Factores de RiesgoAsunto(s)
Enfermedades de los Conductos Biliares/cirugía , Conductos Biliares/cirugía , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomía/efectos adversos , Complicaciones Posoperatorias/cirugía , Enfermedades de los Conductos Biliares/diagnóstico , Conductos Biliares/lesiones , Conductos Biliares/patología , Pancreatocolangiografía por Resonancia Magnética , Humanos , Ligadura , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , ReoperaciónAsunto(s)
Enfermedades de los Conductos Biliares/etiología , Fístula Biliar/etiología , Trasplante de Hígado , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Bilis , Enfermedades de los Conductos Biliares/cirugía , Fístula Biliar/cirugía , Sangre , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Enfermedades de los Conductos Biliares/etiología , Fístula Biliar/etiología , Trasplante de Hígado , Derivación Portosistémica Intrahepática Transyugular/efectos adversos , Bilis , Enfermedades de los Conductos Biliares/cirugía , Fístula Biliar/cirugía , SangreRESUMEN
BACKGROUND: the morbidity and mortality in surgery of gallbladder and biliary tract (SGBT) in the geriatric patient define the prognostic. The aim was to describe the perioperative and immediate post-operative complications of the geriatric patient undergoing SGBT. METHODS: A cross-sectional study with control group in patients older than 60 years was done. The patients were divided into two groups by age (I: 60-69 years and II: > 70 years). The variables analyzed were morbidity, anesthetic risk, type of surgery, perioperative and post-operative complications, conversion rate and length of hospital stay. RESULTS: a total of 236 patients were included: 65.2 % were females with a mean age 68.5 years. Chronic cholelithiasis accounted for 83 % and laparoscopic cholecystectomy was the procedure most commonly performed (72.8 %). Surgery was scheduled in 92 % cases and urgently in 8 %. In both groups, ASA rank was I-II in 76.2 % vs. 70.1 %; the conversion rate was 2.5 %. Complications were 13.5 %, of which 9.3 % were postoperative and 4.2 % of perioperative. Complications were higher in emergency surgery than elective surgery (36.8 % vs. 11.8 %). The average hospital stay was 4.2 days and there was no mortality. CONCLUSIONS: the age does not represent an increase in complications. The laparoscopic cholecystectomy is safe and applicable in elderly. Complications presented were related to the urgent nature of the surgery.
Introducción: en el anciano, la morbilidad posoperatoria en la cirugía de vesícula y vía biliar se relaciona con el pronóstico. Se describen las complicaciones trans y posoperatorias en el anciano sometido a esa cirugía. Métodos: estudio transversal descriptivo en pacientes mayores de 60 años. Se integraron dos grupos: I, pacientes de 60 a 69 años; II, mayores de 70 años. Se registraron comorbilidad, riesgo quirúrgico, tipo de cirugía, complicaciones trans y posoperatorias inmediatas, conversión y estancia hospitalaria. Resultados: se incluyeron 236 pacientes (65.2 % mujeres) con edad media de 68.5 años. La colecistitis crónica litiásica representó 83 % y la colecistectomía laparoscópica se utilizó en 72.8 %. La cirugía fue programada en 92 %. Se identificó ASA I-II en 76.2 y 70.1 % de los grupos I y II, respectivamente; la conversión fue de 2.5 %. Hubo complicaciones en 13.5 % (9.3 % en el posoperatorio y 4.2 % en el transoperatorio) y su proporción fue mayor en las cirugías urgentes (36.8 %) que en las programadas (11.8 %). La estancia hospitalaria fue de 4.2 días. No hubo mortalidad. Conclusiones: las complicaciones no se incrementaron con la edad pero sí con la urgencia de la cirugía. La colecistectomía laparoscópica es segura en geriatría.
Asunto(s)
Enfermedades de los Conductos Biliares/cirugía , Enfermedades de la Vesícula Biliar/cirugía , Complicaciones Intraoperatorias/epidemiología , Complicaciones Posoperatorias/epidemiología , Factores de Edad , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In this article we will review all the anatomic aspects, technics, indications, contraindications and complications of ERCP.