Lesão iatrogênica de via biliar pós-colecistectomia

Abstract

We conducted a retrospective study of medical records of patients admitted to HGF with the diagnosis of IBDI, evaluating the following variables: gender, age, origin, conditions of cholecystectomy, type of surgery, symptoms, exams performed, surgical findings, classification of injury, treatment, complications, total duration of hospitalization and discharge conditions. Results Results ResultsResults Results: There were 27 confirmed cases of IBDI. Two injuries occurred during laparoscopic cholecystectomy cholecystectomy. Only one patient was diagnosed intraoperatively. The most frequent sign was jaundice after cholecystectomy. Hepato-duodenal Y-en-Roux anastomosis was the most often employed surgical technique (85.2%). Most patients were discharged from hospital in good clinical condition (88.8%), however, we found high morbidity rates for this disease, exemplified by the multiple hospitalizations and longer hospital stay (mean 31 days). Conclusion Conclusion Conclusion Conclusion Conclusion: Most injuries occurred during open cholecystectomy, jaundice was the most frequent sign upon admission. There was a high hospitalization length of stay, caused by postoperative complications, which could be explained by delayed diagnosis resulting in a large delay in treatment.

Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy

“…Among various existing classifications for injury to the bile duct stands out Bismuth´s one (1982) 7 , 12 , more used in late stenosis mainly as consequence to thermal injury or bile duct ligature commonly associated with local/regional inflammatory reaction. The bad medical records and late re-intervention difficult classification in this case series 5 , 18 .…”

“…The management of patients with these lesions is very complex, requiring experienced surgeons and mostly specialized services for the treatment of this complication. The prognosis is closely related to clinical conditions and the time between the identification of the lesion and surgical treatment 5 , 6 , 12 .…”

Comparative analysis of iatrogenic lesion of bile ducts in conventional and videolaparoscopic cholecystectomies

“…The incidence of biliary lesion occurs in about one in every 800 procedures. [6][7][8][9][10][11][12][13][14] After the introduction of the laparoscopic surgery, indicated as the gold standard in the treatment of cholecystopathy, the incidence increased to one in every 120 procedures because of the learning curve The management of a patient with iatrogenic lesion of the biliary duct is fairly complex, requiring experienced surgeons and, mostly, specialized services. The prognosis is closely linked to the patient's clinical conditions and the elapsed time between lesion identification and institution of the appropriate surgical treatment.…”

“…3 Factors such as videolaparoscopy, acute cholecystitis, scleroatrophic gallbladder, anatomical variations in the biliary tract, and the learning curve of new surgeons and residents are seen as the main cause of higher incidences of iatrogenic lesions of the biliary tract. [4][5][6][7][8][9][10] Análise comparativa de lesão iatrogênica de Among the 320 patients (62.1%) who underwent conventional CC, four were diagnosed (1.25%) with biliary lesion, corresponding to 0.77% of all patients; all lesions were diagnosed in female patients. All were operated by an assistant surgeon accompanied by second-year residents at the General Surgery Service.…”

Tamoxifen decreases the myofibroblast count in the healing bile duct tissue of pigs

“…With the advent of video laparoscopy, nearly 90% of all cholecystectomies are currently performed laparoscopically, which has resulted in an increased incidence of bile duct injuries (BDIs). The incidence has increased from 0.1-0.2% (open cholecystectomy) to 0.4-0.6% (video laparoscopy) (2,3). Despite their low prevalence, iatrogenic BDIs are significant with regard to their absolute numbers (4) and are important in terms of health care costs (5,6); furthermore, they are among the leading causes of negligence claims against surgeons (7-10).…”