RESUMO
BACKGROUND: The recommended treatment for cholecystocholedocholithiasis is cholecystectomy (CCT) associated with endoscopic retrograde cholangiopancreatography (ERCP). CCT with intraoperative ERCP is associated with higher success rates and lower hospital stays and hospital costs. However, some case series do not describe the exact methodology used: whether ERCP or CCT was performed first. AIMS: Verify if there is a difference, in terms of outcomes and complications, when intraoperative ERCP is performed immediately before or after CCT. METHODS: This is a retrospective case-control study analyzing all patients who underwent CCT with intraoperative ERCP between January 2021 and June 2022, in a tertiary hospital in southern Brazil, for the treatment of cholecystocholedocholithiasis. RESULTS: Out of 37 patients analyzed, 16 (43.2%) underwent ERCP first, immediately followed by CCT. The overall success rate for the cannulation of the bile duct was 91.9%, and bile duct clearance was achieved in 75.7% of cases. The post-ERCP pancreatitis rate was 10.8%. When comparing the "ERCP First" and "CCT First" groups, there was no difference in technical difficulty for performing CCT. The "CCT First" group had a higher rate of success in bile duct cannulation (p=0.020, p<0.05). Younger ages, presence of stones in the distal common bile duct and shorter duration of the procedure were factors statistically associated with the success of the bile duct clearance. Lymphopenia and cholecystitis as an initial presentation, in turn, were associated with failure to clear the bile duct. CONCLUSIONS: There was no significant difference in terms of complications and success in clearing the bile ducts among patients undergoing CCT and ERCP in the same surgical/anesthetic procedure, regardless of which procedure was performed first. Lymphopenia and cholecystitis have been associated with failure to clear the bile duct.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia , Humanos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Colecistectomia/métodos , Colecistectomia/efeitos adversos , Idoso , Adulto , Cuidados Intraoperatórios/métodos , Resultado do Tratamento , Coledocolitíase/cirurgia , Coledocolitíase/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
Introdução: A Gangrena de Fournier é uma fasceítenecrotizante que afeta a região escrotal e a área perineal.Métodos: Foram revisados os prontuários de 8pacientes que tinham o diagnóstico de Gangrena deFournier e que foram submetidos ao tratamento de oxigenioterapiahiperbárica como forma adjuvante entre operíodo de março de 2010 a abril de 2011 no HospitalSão José, Criciúma,SC analisando-se as variáveis: sexo,idade, etiologia, localização da lesão, procedimentoscirúrgicos realizados. Resultados: A maioria foram homenscom idade média de 32,8 anos. O local mais comumde acometimento foi a região urogenital. Agenteetiológico mais frequentemente encontrado foi Enterobacteragglomerans. Todos foram submetidos à desbridamentocirúrgico, sendo que foi realizado colostomiaem três pacientes. A quantidade média de desbridamentoscirúrgicos foi de 2,5. O tempo médio de permanênciahospitalar foi de 45 dias. A média de sessõesem câmera hiperbárica foi de 20,2 sessões. Um pacienteevoluiu para óbito. Discussão: O diagnóstico precocedesta síndrome é fundamental para o sucesso no tratamentoque tem como base a estabilização clínica ecorreção de possíveis distúrbios, além do tratamentocirúrgico que consiste em extenso desbridamento detecidos lesados. A Oxigenioterapia Hiperbárica comométodo adjuvante tem mostrado excelentes resultadose deve ser utilizada como método adicional ao tratamentotradicional com estudos mostrando uma menortaxa de mortalidade. Esta é uma experiência, com númeropequeno de pacientes, porém com excelentes resultadosnos casos realizados.
Introduction: Fournier gangrene is a necrotizing fasciitisaffecting the scrotum and perineal area. Methods:We reviewed the medical records of eight patientswho were diagnosed with Fournier?s gangrene and whounderwent hyperbaric oxygen treatment as adjuvantform between the period march 2010 to april 2011in São José Hospital, Criciúma, SC analyzing variables:gender, age, etiology, lesion location, surgical proceduresperformed. Results: The majority were men with amean age of 32.8 years. The most common site of involvementwas the urogenital region. Etiologic agentwas most frequently found Enterobacter agglomerans.All underwent surgical debridement, and colostomywas performed in three patients. The average numberof debridements was 2.5. The mean hospital stay was45 days. The average number of sessions in the hyperbaricchamber sessions was 20.2. One patient died. Discussion:Early diagnosis of this syndrome is critical tosuccess in treatment is based on clinical stabilizationand correction of potential disturbances, and surgicaltreatment consisting of extensive debridement of injuredtissues. Hyperbaric Therapy as adjunctive methodhas shown excellent results and should be used as an72 additional method to traditional treatment with studiesshowing a lower mortality rate. This is an experience,with small number of patients, but with excellent resultsin cases performed.