Síndrome post-colecistectomía: análisis de una cohorte prospectiva / Post-cholecystectomy syndrome: Descriptive analysis of a prospective cohort

Introducción. El síndrome post-colecistectomía fue descrito hace más de 70 años y se define como la presencia de síntomas gastrointestinales que pueden persistir después de la colecistectomía o aparecer como nuevos síntomas. Este síndrome, poco conocido, puede manifestarse desde pocos meses hasta varios años luego de la cirugía y ocurre entre 5 % y 40 % de los pacientes. Método. Estudio de cohorte prospectiva, que incluyó pacientes a quienes se les realizó colecistectomía laparoscópica en tres unidades quirúrgicas de Bogotá, D.C., Colombia, durante un período de ocho meses, con seguimientos periódicos durante dos años. El síndrome post-colecistectomía se definió como la presencia de al menos un síntoma gastrointestinal a partir del primer mes de la cirugía. Resultados. Se incluyeron 380 pacientes de los cuales 183 (48,2 %) desarrollaron el síndrome. La edad tuvo diferencia estadísticamente significativa entre aquellos que lo desarrollaron y los que no (p=0,024). La diarrea fue el único síntoma preoperatorio asociado al desarrollo del síndrome. El síndrome post-colecistectomía se encontró en el 42,1 % de los pacientes al primer mes de seguimiento y en el 17,4 % al segundo año. Conclusiones. El síndrome post-colecistectomía ocurre en un porcentaje importante de pacientes. En concordancia con la literatura, se encontró que la diarrea prequirúrgica es un factor de riesgo independiente para el desarrollo del síndrome. Se recomienda un adecuado seguimiento de los pacientes después de una colecistectomía

Introduction. Post-cholecystectomy syndrome (PCS) was described more than 70 years ago and is defined as the presence of gastrointestinal (GI) symptoms that may persist after cholecystectomy or can present as new symptoms. This little-known syndrome can appear from a few months to several years after surgery and occurs between 5% and 40% of patients. Method. Prospective cohort study, which included patients who underwent laparoscopic cholecystectomy in three surgical units in Bogotá, Colombia, during a period of eight months, with periodic follow-up for two years. PCS was defined as the presence of at least one GI symptom from the first month after surgery. Results. Three-hundred and eighty patients were included, of which 183 (48.2%) developed the syndrome. Age had a statistically significant difference between those who developed PCS and those who did not (p=0.024). Diarrhea was the only preoperative symptom associated with the development of PCS. Post-cholecystectomy syndrome was found in 42.1% at the first month of follow-up and in 17.4% at the second year. Conclusions. Post-cholecystectomy syndrome occurs in a significant percentage of patients. Consistent with the literature, preoperative diarrhea was found to be an independent risk factor for the development of the syndrome. Adequate follow-up of patients after cholecystectomy is recommended

Association between dietary intake and postlaparoscopic cholecystectomic symptoms in patients with gallbladder disease

BACKGROUND/AIMS: After cholecystectomy, patients have reported postcholecystectomic syndromes such as abdominal symptoms, dyspepsia, and diarrhea, which suggest a relationship between cholecystectomic symptoms and diet, although the details of this association remain unclear. The present study investigated the hypothesis that dietary intake of nutrients and foods was significantly associated with postcholecystectomic syndromes. METHODS: Gallstone patients (n = 59) who underwent laparoscopic cholecystectomy were enrolled, and dietary intake and clinical parameters were assessed immediately postcholecystectomy and 3 months later. RESULTS: There were no significant differences in biochemical measurements or characteristics between symptomatic and asymptomatic patients. Immediately postcholecystectomy, there were no significant differences in consumption of nutrients or foods between symptomatic and asymptomatic patients. However, 3 months after cholecystectomy, symptomatic patients consumed more animal protein, cholesterol, and eggs, and fewer vegetables than did asymptomatic patients. Multivariable-adjusted regression analyses also indicated that the risk for symptoms was positively associated with intake of animal protein, cholesterol, and eggs, but negatively associated with intake of vegetables after adjusting for confounders. In addition, symptomatic patients consumed more bread-based breakfast foods, while asymptomatic patients consumed more rice. CONCLUSIONS: Postcholecystectomic syndromes were positively associated with intake of cholesterol, animal protein, and eggs, and negatively associated with intake of vegetables, suggesting that diet was plays a role in postcholecystectomic syndromes.

Postcholecystectomy syndrome: symptom clusters after laparoscopic cholecystectomy

PURPOSE: Postcholecystectomy syndrome (PCS) is characterized by abdominal symptoms following gallbladder removal. However, there is no consensus for the definition or treatment for PCS. The purpose of this study was to define PCS among various symptoms after laparoscopic cholecystectomy, and to identify risk factors affecting PCS. METHODS: This study was conducted at Dongguk University Ilsan Hospital and Chung-Ang University Hospital (2012–2013). Outcomes were assessed using European Organization for Research and Treatment of Cancer QLQ–C30 questionnaire. Symptom cluster for determining PCS was made by factor analysis. Cluster analysis evaluating risk factors of PCS was made by Ward methods and Dentogram. RESULTS: Factor analysis revealed three distinct symptom clusters, those are ‘insomnia and financial difficulties (eigenvalue, 1.707; Cronbach α, 0.190),’‘appetite loss and constipation (eigenvalue, 1.413; Cronbach α, 0.480),’ and ‘right upper quadrant (RUQ) pain and diarrhea (eigenvalue, 1.245; Cronbach α, 0.315).’ Among these symptom clusters, the cluster of ‘RUQ pain and diarrhea’ was determined as PCS. However, we could not find any risk factors between high symptomatic group and low symptomatic group. CONCLUSION: PCS could consist of RUQ pain and diarrhea. Well-designed prospective trials are needed to determine risk factors of PCS.

Diarrea poscolecistectomía, enfoque diagnóstico y terapéutico / Postcholecystectomy diarrhea, diagnostic and therapeutic approach / Postcholecystectomy diarrhea, aplicação diagnóstica e terapêutica

RESUMEN La colelitiasis es una enfermedad muy prevalente en la población general. El tratamiento de la colelitiasis, cuando se torna sintomática, es fundamentalmente quirúrgico. Una de sus complicaciones es la diarrea pos-colecistectomía que se define como la presencia de 3 o más deposiciones diarreicas por día por más de cuatro semanas en pacientes con el antecedente de colecistectomía, en ausencia de otra causa que explique la sintomatología. Debido a la incidencia reportada en la literatura alrededor del 15%, esta revisión presenta la epidemiologia, fisiopatología, diagnóstico, clasificación y tratamiento de esta patología. Adicionalmente se plantea una nueva clasificación de la patología que se correlacione con la fisiopatología.

ABSTRACT Cholelithiasis is a highly prevalent disease in general population. Treatment of cholelithiasis when it becomes symptomatic is fundamentally surgical. One of its complications is postcholecystectomy diarrhea that is defined as the presence of 3 or more watery depositions for a period longer than 4 weeks in patients with the surgical background in the absence of another cause that explains symptoms. Due to incidence reported in literature of 15%, this review presents epidemiology, physiopathology, diagnosis, classification and treatment of this disease. Additionally, a new classification of the pathology is proposed that correlates with the physiopathology.

RESUMO A colelitíase é uma doença altamente prevalente na população em geral. O tratamento da colelitíase quando se torna sintomático é fundamentalmente cirúrgico. Uma das suas complicações é a diarréia pós-elelectomicária que é definida como a presença de 3 ou mais deposições aquosas por um período superior a 4 semanas em pacientes com fundo cirúrgico na ausência de outra causa que explica sintomas. Devido à incidência relatada na literatura de 15%, esta revisão apresenta epidemiologia, fisiopatología, diagnóstico, classificação e tratamento desta doença. Além disso, propõe-se uma nova classificação da patologia que se correlaciona com a fisiopatologia.

Diarrea poscolecistectomía: ¿un problema frecuente? / Postcholecystectomy diarrhea is a frequent problem?

Resumen Introducción: La colecistectomía laparoscópica es una de las intervenciones quirúrgicas más frecuentes en nuestro país. La diarrea poscolecistectomía es una entidad poco reconocida, con una prevalencia descrita entre el 0,9 y 35,6%, sin embargo, en Chile esto no ha sido claramente definido. Objetivo: Determinar la prevalencia y características de la diarrea poscolecistectomía laparoscópica electiva en una muestra de pacientes chilenos. Material y métodos: Se aplicó una encuesta telefónica estructurada sobre consistencia y frecuencia de deposiciones, entre 4 y 6 meses después de la intervención, a los pacientes adultos operados de colecistectomía laparoscópica electivamente entre diciembre de 2014 y marzo de 2015. Se definió como «diarrea poscolecistectomía¼ la presencia de deposiciones líquidas o inusualmente disgregadas que hubiesen comenzado posteriormente a la intervención y se estableció el término de «diarrea prolongada¼ como la duración de síntomas mayor de 4 semanas. Resultados: Se encuestó a 100 pacientes (73% de mujeres). La prevalencia global de diarrea poscolecistectomía fue del 35% (n = 35). La prevalencia de pacientes con diarrea prolongada fue del 15% (n = 15). En el grupo con diarrea prolongada, se observó resolución completa de esta en el 57% de los pacientes (n = 8) en un plazo medio de 99 ± 29 días. Conclusión: La diarrea poscolecistectomía es una entidad frecuente en nuestra población, con una alta prevalencia dentro de los primeros 28 días posteriores a la intervención. En la mayoría de los pacientes se resuelve en los primeros 6 meses.

Abstract Introduction: Laparoscopic cholecystectomy (LC) is one of the most common surgical procedures in our country. Postcholecystectomy diarrhea is an unrecognized entity, with a reported prevalence between 0.9 and 35.6%, nonetheless in Chile this has not been clearly defined. Objective: To determine the prevalence and characteristics of diarrhea following elective laparoscopic cholecystectomy in our institution. Material and methods: A structured questionnaire about consistency and defecation frequency was applied to adult patients summited to an elective LC between December 2014 and February 2015, by a telephone survey within 4 and 6 months after the surgical procedure. Postcholecystectomy diarrhea was defined as the presence of liquid or unusually disrupted faecal material beginning after LC. Persistent diarrhea was established when diarrhea continued for a period longer than four weeks. Results: One hundred patients were included (73% women). The overall prevalence of postcholecystectomy diarrhea was 35% (n = 35). The prevalence of patients with persistent diarrhea was 15% (n = 15). In the group of patients with persistent diarrhea, complete resolution was observed on 57% of the cases (n = 8) within an average period of 99 ± 29 days. Conclusion: Post cholecystectomy diarrhea is a frequent condition in our population, with a high prevalence within the first 28 days after LC. In most patients it resolved within 6 months.

Síndrome poscolecistectomía: problema frecuente, poco tratado / Postcholecystectomy syndrome: a common but scarcely studied condition

Se comentan los principales aspectos clínicos del síndrome poscolecistectomía, las dificultades para su comprensión y atención, así como la escasa alusión a este cuadro en los programas convencionales de pregrado y posgrado médicos. Se hace énfasis en el creciente número de pacientes que son sometidos a intervenciones de vesícula biliar realizadas por mínimo acceso a través de la videolaparoscopia, donde hay un porcentaje potencial de enfermos que desarrollan este síndrome y que acuden a los servicios de salud...

Comments are provided on the main clinical aspects of the postcholecystectomy syndrome, the difficulties involved in its comprehension and treatment, and the scant reference to this condition in conventional undergraduate and graduate syllabuses. Emphasis is made on the growing number of patients undergoing minimal access videolaparoscopic cholecystectomy, a potential proportion of whom will develop the syndrome and request medical care...

Fate of Dyspeptic or Colonic Symptoms After Laparoscopic Cholecystectomy

BACKGROUND/AIMS: Gallbladder diseases can give rise to dyspeptic or colonic symptoms in addition to biliary pain. Although most biliary pain shows improvement after cholecystectomy, the fates of dyspeptic or colonic symptoms still remain controversial. This study assessed whether nonspecific gastrointestinal symptoms improved after laparoscopic cholecystectomy (LC) and identified the characteristics of patients who experienced continuing or exacerbated symptoms following surgery. METHODS: Sixty-five patients who underwent LC for uncomplicated gallbladder stones or gallbladder polyps were enrolled. The patients were surveyed on their dyspeptic or colonic symptoms before surgery and again at 3 and 6 months after surgery. Patients' mental sanity was also assessed using a psychological symptom score with the Symptom Checklist-90-Revised questionnaire. RESULTS: Forty-four (67.7%) patients showed one or more dyspeptic or colonic symptoms before surgery. Among these, 31 (47.7%) and 36 (55.4%) patients showed improvement at 3 and 6 months after surgery, respectively. However, 18.5% of patients showed continuing or exacerbated symptoms at 6 months after surgery. These patients did not differ with respect to gallstone or gallbladder polyps, but differed in frequency of gastritis. These patients reported lower postoperative satisfaction. Patients with abdominal symptoms showed higher psychological symptom scores than others. However, poor mental sanity was not related to the symptom exacerbation. CONCLUSIONS: Elective LC improves dyspeptic or colonic symptoms. Approximately 19% of patients reported continuing or exacerbated symptoms following LC. Detailed history-taking regarding gastritis before surgery can be helpful in predicting patients' outcome after LC.

Laparoscopic Resection for the Treatment of Symptomatic Remnant Huge Cystic Duct with Stone after Laparoscopic Cholecystectomy

During laparoscopic cholecystectomy, the cystic duct is frequently divided closer to the gallbladder to avoid iatrogenic injury to the common bile duct. Postcholecystectomy syndrome can be considered if the patient complains of right upper abdominal discomfort after cholecystectomy. We report a case of a laparoscopic resection for the treatment of a symptomatic remnant huge cystic duct with stones after a previous laparoscopic cholecystectomy. A 46-year-old male was admitted to our hospital due to right upper quadrant abdominal pain. Five years earlier, the patient had undergone a laparoscopic cholecystectomy under the diagnosis of acute calculous cholecystitis but he subsequently suffered from intermittent right upper abdominal pain and fever. An abdominal computed tomography scan revealed a stone in a dilated remnant cystic duct. A laparoscopic remnant cystic duct resection was performed and apathologic diagnosis was made with chronic calculus cystic duct inflammation. The patient was discharged without complications and has been doing well without recurrent symptoms.

Surgery vs. endoscopy competitive or complementary tools for management of post cholecystectomy problems, 10 years experience in major referral center

A prospective work to study and evaluate surgical and endoscopic techniques used in management of post cholecystectomy problems. In the period from Mars 2000 to October 2009, a random sample of 630 patients [366 females and 264 males] were collected from general surgery department, and gastro-intestinal endoscopy unit, Assuit University hospitals, and managed accordingly using surgery in 143 patients, and endoscopy in 482 patients [plus percutaneous techniques in 25 patients]. Endoscopy was very successful. as an initial treatment of 457 patients [73%], as being less invasive, low morbidity and mortality, competitive to surgery in treatment of missed stone [88%], mild to moderate biliary leakage [82%], and biliary stricture [74%].Its success increased by addition of percutaneous techniques in 4%, 2.8% and 8.3% for missed stone, leakage, and stricture respectively. But endoscopy was somewhat complementary to surgery in major leakage, and massive stricture, and surgery was resold to in 15%, and 17% of cases. Surgery remain as the treatment of choice in complex problems, and endoscopy play a complementary role in such cases of transaction, ligation, combined problems of stones, stricture, and leakage [< 40%], compared to 60% for surgery. Bilio-enteric anastomosis was the procedure of choice, done in 86 cases, with stent splintage in unhealthy, or small sized ducts. And stricture complication was encountered in 6% of cases treated by perculaneous rout in 4, and redo surgery in1 case. The learning curve seems influential in both endoscopy and surgery. The cumulative experience increase the success rate of endoscopy from initial 50% to 95% nowadays, also surgery improved with decreased morbidity and mortality as complications encountered was seen in initial experience and decreased with time. Endoscopy was competitive to surgery in simple problems and advised to be the initial treatment choice, but complementary in major leak, ligation, transection, and complex problems, where surgery plays the main role in treatment with its invasiveness, high morbidity and morbidity. Cumulative experience influence endoscopic and surgical treatment of such problems and it is mandatory with other facility and equipment for management of such challenging cases

Hidatidosis humana: dos casos de complicación severa / Human hydatidosis: two cases with severe complications

Se presentan dos enfermos afectados de hidatidosis humana complicada. Un paciente portador de un quiste hidatídico hepático que ingresa por un síndrome coledociano por presencia de hidátides en la vía biliar y una paciente con hidatidosis pulmonar bilateral, que evoluciona también con complicación de sendos quistes en su pre y post operatorio. Se concluye en la discusión planteada sobre la táctica quirúrgica del segundo enfermo, acerca de la conveniencia de la toracotomía bilateral o sucesiva.

Two patients present complicated human hydatidosis. One of them -a male patient-, presents an hepatic hydatid cyst and is admitted due to a choledocian syndrome caused by the presence of hydatides in the bile duct. The other one -a female patient-, presents bilateral pulmonar hydatidosis that also evolves with complications in both cysts pre- and post-surgery. The conclusion is expressed in the discussion presented on the surgical tactics for the second patient and the convenience of bilateral or succesive thoracotomy.

Síndrome Sump: um relato de caso / Sump Syndrome: a case report

Objetivos: descrever o diagnóstico e tratamento de um caso de Síndrome Sump. Descrição do Caso: uma mulher de 33 anos vinha apresentando episódios recorrentes de dor abdominal, acompanhados de febre e calafrios. A paciente havia sido submetida previamente à cirurgia de vias biliares, sendo realizado o diagnóstico atual de Síndrome Sump. Optou-se pelo tratamento cirúrgico, diante da impossibilidade de tratamento endoscópico. Conclusões: a Síndrome Sump, entidade rara na atualidade, consiste em uma complicação da coledocoduodenoanastomose, causada pelo contato de resíduos gástricos com o colédoco distal, levando à sua obstrução. Deve ser lembrada como causa de colangite de repetição.

Aims: To describe the diagnosis and treatment of a case of Sump Syndrome. Case Description: A 33 years old woman presented recurrent episodes of abdominal pain accompanied by fever and chills. The patient had previously undergone surgery of the biliary tract, and the current diagnosis of Sump Syndrome was performed. A surgical treatment was indicated given the impossibility of endoscopic treatment. Conclusions: The Sump Syndrome, rare nowadays, consists of a complication of choledocoduodenoanastomosis caused by contact of gastric residues with the distal common bile duct, causing obstruction. It should be considered as a cause of recurrent cholangitis.

Successful Endoscopic Papillary Balloon Dilatation for a Patient with Recurrent Sump Syndrome / 대한소화기내시경학회지

Sump syndrome is a rare late complication of choledochoenteric anastomosis, and this caused by the accumulation of food debris, choledocholithiasis, bile sludge and cholesterol crystals in the distal common bile duct. This syndrome is characterized by symptoms such as abdominal pain and fever. The treatment modality for this syndrome has been surgery in the past. However, endoscopic treatment such as endoscopic sphinterotomy is currently regarded as the primary therapeutic approach for this condition. We experienced a patient with a history of choledochoduodenostomy and who developed sump syndrome as a complication of the surgery. Endoscopic sphinterotomy was performed for treatment, but this only produced the recurrence of the disease. The recurrent sump syndrome was eventually successfully controlled by performing endoscopic papillary balloon dilatation.

Clinical Usefulness of Laser Cystectomy

PURPOSE: To evaluate the usefulness of laser cystectomy for the treatment of patients with dacryocystitis and sump syndrome. METHODS: Thirteen patients (13 eyes) diagnosed with acute or chronic dacryocystitis, and nine patients (9 eyes) who developed sump syndrome after dacryocystorhinostomy from 2005 to 2006 underwent laser cystectomy and endonasal dacryocystorhinostomy. RESULTS: Pain and swelling around the orbit improved immediately after the operation in patients with acute dacryocystitis, and all symptoms of sump syndrome disappeared by 1 month postoperatively. Epiphora reduced in all patients. During the follow-up period, functional nasolacrimal duct obstruction occurred in one eye and membranous obstruction developed in two eyes. In these two eyes with membranous obstruction, revisional surgery was performed successfully. No recurrence of dacryocystitis was noticed. CONCLUSIONS: Laser cystectomy with endonasal dacryocystorhinostomy is a simple and effective treatment modality for patients with dacryocystitis and sump syndrome that minimizes the risk of recurrence.

A Case of Small Intestinal Obstruction due to Bezoars Accompanied with Sump Syndrome / 대한소화기내시경학회지

Sump syndrome is one of the late complications of a side to side choledochoduodenostomy, but it is a rare malady. The anastomosis of the bile duct and small bowel results in exclusion of the distal limb of the common bile duct from drainage of bile with the potential formation of a sump. Food material and bile sludge may accumulate in distal segment of common bile duct and so this cause recurrent bile duct stones. Bezoars frequently result from disturbed passage of the gastrointestinal tract, especially after surgery, and it may develop various symptoms by irritating or obstructing the gastrointestinal tract. The bezoar accompanied with sump syndrome after choledochoenterostomy has not yet been reported in the literature. We report here on a case of small intestinal obstruction due to bezoars accompanied with sump syndrome.

The Surgical Results of Endonasal DCR with Two Silicone Tubes in Common Canalicular Obstruction

PURPOSE: To evaluate the surgical results of endonasal dacrocystorhinostomy with two silicone intubation in common canalicular obstruction. METHODS: Forty patients (57 eyes) who complained of tearing due to common canalicular obstruction underwent endonasal dacryocystorhinostomy. In this study, We randomly divided patients into two groups. One group underwent one-silicone tube intubation (29 eyes, group A) and the other group underwent two-silicone tube intubation (28 eyes, group B). After surgery, we compared the success rates and the causes of surgical failure between the two groups. RESULTS: There were no significant differences between the two groups with regard to age, sex, duration of silicone intubation, or follow-up time. The primary success rates of the group A and the group B were 65.5% (19/29) and 85.7% (24/28) [(P=0.078)], respectively. the final success rates after the revisional surgery were 76.4% (21/29) and 92.8% (26/28) [(P=0.043)] respectively. Primary causes of surgical failure in the group A were: membranous obstruction of the internal ostium (6), common canalicular re-obstruction (2), sump syndrome (1), and functional obstruction (1). The main causes of surgical failure in the group B were: membranous obstruction of the internal ostium (2), and granuloma formation (2). CONCLUSIONS: We believe that endonasal dacryocystorhinostomy with two-silicone tube intubation might be an excellent alternative treatment modality in order to improve success rates in common canalicular obstruction.

Estenosis de colédoco: reporte de caso / Choledocho stenosis: clinic case

Se reporta el caso de una paciente de sexo femenino de 24 años de edad que presentó estenosis de colédoco, cuyo cuadro clínico evoluciona durante siete meses a raíz de intervención quirúrgica por colecistectomía. La fistulografía demostró dilatación de las vías biliares intra y extrahepáticas y obstrucción del colédoco. Las estenosis benignas de los conductos biliares ocurren en el 97% de los casos, por lesión accidental durante actos quirúrgicos. En 1 de 400 colecistectomías convencionales, y en 1 de 200 colecistectomías laparoscópicas, se produce un daño a la vía biliar que provoca el desarrollo de la estrechez de la misma.

Report the case a female patient, with 24 years old that present choledocho stenosis, which clinic development for seven month since the surgery for cholecystectomy. The fistulography show a dilation pf intra and extrahepatic biliar tract and choledoco obstruction. The benign stenosis of the biliar tracts present in 97% of the cases by accidental damage during surgical procedure. In 1 of 400 conventional cholecystectomies and 1 of 200 laparoscopies cholecistectomy, produce a damage of biliar tract that cause a growth of the narrowness

Anestesia conductiva en colecistectomías abiertas: una mejor alternativa en cirugía y relación costo beneficio / Conductive anesthesia in open cholecystectomies: a better alternative in surgery and cost-benefit relationship

Se realizó un estudio retrospectivo de tipo descriptivo, con la revisión de 180 historias médicas de pacientes que ingresaron por el servicio de cirugía, a los cuales se les practicó colecistectomia abierta con anestesia subdural, en el Hospital Fundahosta para el período enero del 2000 hasta enero del 2004, los datos fueron obtenidos de acuerdo a la recolección de 10 parámetros, correspondientes al año de la intervención quirúrgica, edad, sexo, diagnóstico preoperatorio, postoperatorio, modalidad de anestesia, número de aguja subdural, complicaciones, tiempo de estancia, hospitalaria y costo del servicio. Nuestro objetivo es dar a conocer las ventajas que ofrece la anestesia conductiva subdural en relación a la reducción del tiempo operatorio, escasas complicaciones, mejor relación costo beneficio con el que cuenta la institución y garantizar la eficacia de las intervenciones electivas a los pacientes que serán sometidos a este procedimiento.

Laparoscopic Removal of a Retained Gallbladder with Remnant Cystic Duct Calculi

Laparoscopic cholecystectomy has been widely performed as a gold standard in patients with symptomatic gallstone disease. To avoid bile duct injury during operation, it is recommended that dissection should be kept close to the gallbladder despite the potential risk of long cystic duct stump. Post-cholecystectomy syndrome refers to a wide spectrum of conditions that often pose a diagnostic and therapeutic dilemma for surgeon. Cystic duct remnant may cause postcholecystectomy syndrome in the presence of stones. A case is presented in which a symptomatic gallbladder remnant with gallstone was removed successfully by laparoscopic technique. In the era of laparoscopic surgery, which favors a long cystic duct remnant, we should be aware of cystic duct remnant stones as a possible cause of post-cholecystectomy syndrome.

Adenoma velloso del colédoco con transformación maligna hacia adenocarcinoma bien diferenciado / Coledochal vellous adenoma with malignant transformation

Informar el caso de una paciente de 55 años de edad con diagnóstico de adenoma velloso del colédoco con transformación maligna. Descripción del caso clínico y revisión de la literatura. Servicio de Cirugía General del Instituto Autónomo Hospital Universitario de Los Andes. Mérida-Venezuela. Se realizó operación de Whipple modificada obteniéndose diagnóstico histológico de adenoma velloso en colédoco con transformación maligna hacia adenocarcinoma bien diferenciado. El adenoma velloso del colédoco es una entidad clínica patológica inusual, y su abordaje puede verse dificultado por ser poco documentado. Obtener un diagnostico definitivo previo es necesario para realizar el procedimiento quirúrgico apropiado.