Colecistectomía difícil

Abstract

RESUMEN Introducción. La colecistectomía laparoscópica (CL) es considerado el estándar de oro, sin embargo, la disrupción de la vía biliar (DVB) sigue siendo más frecuente en el procedimiento laparoscópico que abierto. Existen características que predisponen una colecistectomía difícil (CD), término que no ha sido definido universalmente, pero se refiere a una inflamación severa de la vesícula y las estructuras circundantes, dando como resultado un triángulo de Calot fusionado, vesícula gruesa o contraída, piocolecisto, síndrome de Mirizzi, perforación de vesícula, entre otros. Se han establecido medidas para una CL segura, como la colecistectomía subtotal, para disminuir la tasa de complicaciones. Objetivo. Describir la resolución quirúrgica para colecistectomías “difíciles”, así como las complicaciones e identificar las características demográficas de la población en el Centenario Hospital Miguel Hidalgo en el periodo (2016-2021). Materiales y Métodos. Estudio descriptivo, retrospectivo, transversal. Se efectúo revisión de los expedientes de los pacientes programados a CL en el periodo de 2016-2021. Se excluyeron todos los pacientes que no cumplían con la definición de CD. Resultados. Se obtuvieron 145 pacientes, 94 fueron mujeres, 51 hombres; edad promedio fue de 45 años. (49%) no tenía comorbilidades, 37% habían tenido cirugías abdominales previas. 7 pacientes tuvieron colangitis, 11 pancreatitis, 29 con riesgo de coledocolitiasis, 119 colecistitis aguda. 47% de los ultrasonidos no mostraba agudización. Se utilizó la escala de Parkland para definir CD a partir de Parkland III, incluyendo hidrocolecisto, piocolecisto y vesícula escleroatrófica. 42.8% fueron III, 16.6% IV y 26.9% V. DVB (2.1%) Strasberg A, 2 (1.4%) presentaron hemorragia, 2 (1.4%) absceso. La mortalidad fue un paciente por choque hipovolémico. Se reintervinieron 5, 15 se convirtieron y 4 fueron colecistectomías subtotales. Conclusión. La CL total para CD es segura nuestro hospital con un porcentaje de DVB (0%) inferior al descrito en la literatura (0.15-0.36%), sin incluir fuga biliar (Strasberg A).

ABSTRACT INTRODUCTION. Laparoscopic Cholecystectomy (LC) is considered the gold standard treatment for acute cholecystitis. However, bile duct disruption (BVD) continues to be more common in laparoscopic procedures than in open surgery. Some characteristics predispose a difficult cholecystectomy (DC), a still undefined term, but refers to severe inflammation of the gallbladder and surrounding structures resulting in a series of complications such as fused triangle of Calot, thick or contracted gallbladder, pyocholecyst, Mirizzi syndrome, gallbladder perforation, among others. Measures for a safe LC have been established to reduce the rate of complications, such as subtotal cholecystectomy. AIMS. Describe the surgical resolution for "difficult" cholecystectomies, in addition to the complications, and identify the demographic characteristics of this population at the Centenario Hospital Miguel Hidalgo in the period (2016-2021). MATERIALS AND METHODS. Descriptive, retrospective, cross-sectional study. A review of the medical records of the patients scheduled for LC in the period 2016-2021 was carried out. All patients who did not meet the definition of DC were excluded. RESULTS. 145 patients were obtained (94 women, 51 men). The average age was 45 years. 49% of patients had no comorbidities, and 37% had had previous abdominal surgeries. 7 patients had cholangitis, 11 presented pancreatitis, 29 had the risk of choledocholithiasis, and 119 showed acute cholecystitis. 47% of the ultrasounds did not show exacerbation. The Parkland scale was used to define DC based on the score Parkland III, including hydrocholecyst, pyocholecyst, and scleroatrophic vesicle. 42.8% had a score of III, 16.6% added up a score of IV and 26.9% reckoned a score of V. The 2.1% of patients presented DVB classified as Strasberg A, 2 patients (1.4%) presented hemorrhage, and 2 (1.4%) had an abscess. The total number of deceased patients was one due to hypovolemic shock. 5 patients underwent reoperation, 15 procedures were converted from laparoscopy to open surgery and 4 were subtotal cholecystectomies. CONCLUSION. Total LC for DC is safe in our hospital with a DVB percentage (0%) lower than the described in the literature (0.15-0.36%), without including bile leak (Strasberg A).