Complicações da cirurgia videolaparoscópica no tratamento de doenças da vesícula e vias biliares

Abstract

RACIONAL: O tratamento de escolha para as doenças da vesícula biliar é a colecistectomia, cujo objetivo é o alívio de sintomas e o tratamento e/ou prevenção das complicações. OBJETIVO: Identificar as principais complicações da cirurgia videolaparoscópica no tratamento das doenças da vesícula biliar e vias biliares. MÉTODO: Realizou-se busca eletrônica na base de dados LILACS e Medline desde o ano de 1981 a agosto de 2007; foram encontrados 57 artigos, sendo utilizados para o estudo 31 e três capítulos de livros. RESULTADOS: A produção científica submetida à análise de conteúdo evidenciou os seguintes núcleos temáticos: variações anatômicas (3 artigos), iatrogenias (5 artigos), síndrome pós-colecistectomia (1 artigo), complicações raras (3 artigos), síndrome de Mirizzi (1 artigo), complicações pulmonares (2 artigos) e tratamento (1 capítulo de livro e três artigos). CONCLUSÕES: As complicações que podem ocorrer na cirurgia videolaparoscópica da vesícula biliar e das vias biliares têm basicamente duas vertentes: uma é a inexperiência dos cirurgiões com o método laparoscópico (curva de aprendizado) e outra, as variações anatômicas com as quais os cirurgiões, mesmo os mais experientes, podem se deparar.

Comparative study between ligature with thread or metallic clamping by means of laparoscopy with the purpose of experimental biliary obstruction in swines

“…Obstructive procedures occurred without difficulty, mainly due to the visibility of the structures proper proportion through the screen provided by the device. This fact, which is associated with the maximization of the image of the organs in video monitors, allows you to define the exact site of action, providing safe interventions to vital structures, even in complicated cases 28,29,44,45 . Experimental induction of extrahepatic cholestasis is a process that does not always succeed, requiring a high degree of technical quality, patience, concentration and continuous training 46,47 .…”

“…The treatment of biliary obstructions depends on the time between occurrence and diagnosis of the injury and, the type, extent and location of same in the bile ducts 14,25 , being the surgical treatment the most recommended 2,26 . In this context, the development and evolution of laparoscopic surgery have stimulated the execution of operative techniques increasingly complex; even considered safe, the procedure requires extensive anatomical knowledge and training aimed at reducing the incidence of postoperative complications 25,[27][28][29][30][31][32] . Assess any changes in liver and biliary tree due to biliary obstruction is of great importance, because it aids in clinical diagnosis of the patient, improving the quality and efficiency of treatment.…”

Estudo randomizado para avaliação da dieta hipolipídica nos sintomas digestivos no pós-operatório imediato da colecistectomia por videolaparoscopia

“…Other symptoms may be caused by disorders directly related to cholecystectomy, such as biliary stenosis, retained calculi, stenosis or dyskinesia of the sphincter of Oddi, diarrhea induced by bile salts and long remnant cystic duct 3,5,10,13,14 . On the other hand, opioids and other drugs used in high doses in general anesthesia, such as alfentanil and fentanyl citrate and morphine derivatives, have side effects such as nausea and vomiting, and reduce gastrointestinal motility, causing constipation 1,6 .…”

“…The goal of surgery is to relieve symptoms and to treat and/or prevent complications 1,3,4 . However, in about 10% to 50% of patients undergoing cholecystectomy, symptoms persist or new ones develop 1,3 . The persistence or onset of symptoms after surgery is called post-cholecystectomy syndrome 2 .…”

“…The persistence or onset of symptoms after surgery is called post-cholecystectomy syndrome 2 . These symptoms are usually mild and nonspecific, comprising flatulence, nausea, belching and indigestion 1,3 .…”