Optimización en La Estrategia Diagnóstica Y Terapéutica en El Quiste De Colédoco

Abstract

Optimization in diagnostic and therapeutic strategy of choledochal cystObjectives: The choledochal cyst has an incidence of 1 in 100.000-150.000. The purpose of this study was to analyze the variables introduced for the optimization in the diagnosis and treatment of choledochal cyst. material and methods: Retrospective study of patients treated in our center by hepatic-jejunostomy and Roux-Y, from September 1988 to november 2012. We analyzed 40 variables including age, symptoms, type of cysts, diagnostic tests, changes in surgical technique, complications and outcomes. results: Eighteen patients (66.6% female) were grouped according to the age of presentation: Prenatal (< 1 month), Early (1-24), Delayed (> 24 months). The most common symptoms were jaundice and abdominal pain (for early-onset and late-onset respectively). The 83.3% presented choledochal cysts type I, the ultrasound was sufficient for diagnosis in 94.4%. Since 2004 we modified the surgical technique, performing laparoscopic dissection of the bile duct and cyst, adding a mini-laparotomy (3-5 cm) for hepatic-jejunostomy with 40 cm intestinal loop using polypropylene suture. One complication was observed since 2004, one case of partial dehiscence of the anastomosis resolved with conservative treatment and a cholangitis in 1 patient with hepatic and renal polycystic. In 2012, 83.3% are asymptomatic. conclusions: The diagnostic have been simplified, in more than 90% of cases was done by ultrasound; advances in minimally invasive surgery and creation of descending loop of 40 cm, have helped to improve the prognosis of choledochal cyst.

Quiste de colédoco

“…Dentro del protocolo para el manejo del quiste de colédoco, se debe clasificar mediante estudios de imagen, de los cuales la colangio-RM es el de elección, al no contar con colangiorresonancia se utiliza CPRE en el presente caso, lo cual permite identificar la anatomía del quiste y planear el manejo quirúrgico, 12 que consiste en resección completa del quiste más una hepatoenteroanastomosis en Y de Roux, la cual en la actualidad se puede realizar por vía laparoscópica. [13][14][15] En nuestro caso se realiza de manera satisfactoria colecistectomía y hepatoenteroanastomosis en Y de Roux abierta, debido a que en la unidad no se cuenta con equipo ni experiencia en derivaciones biliodigestiva-laparoscópicas, obteniendo resultados favorables con la paciente; se cita nuevamente al mes, seis meses y al año, con paraclínicos de control con pruebas de funcionamiento hepático, con valores dentro de parámetros normales.…”