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1.
Rev. colomb. cir ; 37(3): 480-491, junio 14, 2022.
Article in Spanish | LILACS | ID: biblio-1378833

ABSTRACT

Introducción. La colelitiasis tiene una prevalencia del 15 % y el 21 % tendrá coledocolitiasis al momento de la colecistectomía, con 50 % de probabilidad de presentar complicaciones asociadas. Desde el advenimiento de la colecistectomía laparoscópica, el abordaje de la coledocolitiasis ha sido endoscópico, usualmente en un tiempo diferente al vesicular, sin embargo, los avances en laparoscopia han permitido explorar la vía biliar común por la misma vía, pudiendo realizar ambos procedimientos en el mismo tiempo de forma segura. Métodos. Se realizó una búsqueda de la literatura existente con relación al enfoque para el manejo de la colecisto-coledocolitasis en un paso comparado con dos pasos. Resultados. Existe evidencia que demuestra mayor efectividad del abordaje en dos pasos, con CPRE y posterior colecistectomía laparoscópica, sobre el abordaje en un paso, especialmente en la tasa de fuga biliar y de cálculos retenidos. El enfoque en un paso con exploración de vías biliares y colecistectomía laparoscópica en el mismo tiempo es seguro, con alta tasa de éxito, baja incidencia de complicaciones, menor estancia hospitalaria y costos. Conclusión. El abordaje laparoscópico en un solo paso es un procedimiento seguro y eficaz para el manejo de la colecisto-coledocolitiasis, con el beneficio de estancia hospitalaria menor, sin embargo, se requieren habilidades técnicas avanzadas en cirugía laparoscópica. En nuestro medio ya existe una infraestructura para el manejo híbrido con CPRE y colecistectomía laparoscópica, pudiéndose realizar ambos en el mismo tiempo, para reducir estancia y costos.


Introduction. Cholelithiasis has a prevalence of 15%, and 21% will have choledocholithiasis at the time of cholecystectomy, with a 50% probability of presenting associated complications. Since the advent of laparoscopic cholecystectomy, the approach to choledocholithiasis has been endoscopic, normative at a different time than the gallbladder; however, advances in laparoscopy have made it possible to explore the common bile duct by the same route, being able to perform both procedures in a single time safely. Methods. A search of the existing literature was performed regarding the one-step approach compared to the two-step approach for the management of cholelithiasis and choledocholithiasis. Results. There is evidence that demonstrates greater effectiveness of the two-step approach with ERCP and subsequent laparoscopic cholecystectomy over the one-step approach, especially in the rate of bile leak and the incidence of retained stones. The one-step approach with bile duct exploration and laparoscopic cholecystectomy at the same time is safe, with a high success rate, low incidence of complications, shorter hospital stay, and lower costs. Conclusion. The one-step laparoscopic approach is a safe and effective procedure for the management cholelithiasis and concomitant choledocholithiasis, with the benefit of a shorter hospital stay; however, advanced technical skills in laparoscopic surgery are required. In our environment there is already an infrastructure for hybrid management with ERCP and laparoscopic cholecystectomy, both of which can be performed at the same time to reduce hospital stay and costs.


Subject(s)
Humans , Bile Ducts , Cholelithiasis , Choledocholithiasis , Cholecystectomy , Cholangiopancreatography, Endoscopic Retrograde , Laparoscopy
2.
Article in Chinese | WPRIM | ID: wpr-927877

ABSTRACT

Objective To evaluate the safety and effectiveness of laparoscopic common bile duct exploration in the treatment of common bile duct stones. Methods A retrospective analysis was conducted for 158 patients with cholecystolithiasis and choledocholithiasis admitted to the Number One Hospital of Zhangjiakou from January 2015 to December 2019.The patients were assigned into three groups according to the diameters of cystic duct and common bile duct,degrees of abdominal infection and tissue edema,and operation method.Group A(16 cases):laparoscopic cholecystectomy,transcystic choledochoscopic exploration for stone removal;Group B(94 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,T tube drainage;Group C(48 cases):laparoscopic cholecystectomy,common bile duct incision exploration combined with choledochoscopy for stone removal,primary closure of the common bile duct.The operation time,residual rate of stones,and complication(bleeding,bile leakage,and wound infection) rate were compared between groups. Results The operation time of groups A,B,and C was(95.1±14.7),(102.2±18.1),(110.1±16.4) minutes,respectively,which showed no statistical difference between each other(F=0.020,P=0.887).One case in group A had residual stones,while no residual stone appeared in groups B and C.The overall stone clearance rate was 99.4% and the overall complication rate was 1.9%.There was no perioperative death. Conclusion It is generally safe and effective to carry out laparoscopic cholecystectomy and common bile duct exploration for stone removal in suitable populations.


Subject(s)
Choledocholithiasis/surgery , Common Bile Duct/surgery , Gallstones/surgery , Humans , Laparoscopy/methods , Retrospective Studies
4.
Rev. argent. cir ; 113(4): 427-433, dic. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1356952

ABSTRACT

RESUMEN Antecedentes: la litiasis biliar tiene una prevalencia actual en Occidente del 10-20%. El 7-16% de los pacientes presentan también coledocolitiasis. El diagnóstico preoperatorio de coledocolitiasis es difícil de establecer. Objetivo: establecer nuestra experiencia en el estudio de la patología biliar complicada y el manejo de la coledocolitiasis en dos tiempos, como terapéutica de elección. Material y métodos: estudio prospectivo, observacional. Pacientes con patología biliar sometidos a procedimientos en el Servicio de Cirugía General del Hospital Vidal, desde el 30/06/2019 al 30/12/2019. Resultados: la ecografía hepato-bilio-pancreática (HPB) es específica, con exactitud del 80,9% y sensibilidad del 50%. La colangio resonancia magnética (CRNM) es 100% específica, tiene exactitud del 84,6% y sensibilidad de 67%. La colangio pancreatografía retrógrada endoscópica (ERCP -por sus siglas en inglés-), durante la primera colangiografía mostró en el 100% litiasis coledociana, pero, luego del tratamiento, la colangiografía de "control" muestra 0% de sensibilidad, 100% especificidad, con exactitud del 15,4%. En los hallazgos intraoperatorios, el cístico dilatado en asociación con alteraciones humorales ha demostrado una sensibilidad del 100%, especificidad del 90% y tasa de exactitud de 93,6%. Conclusión: la colangiografía intraoperatoria (CIO) es el procedimiento de referencia ("gold standard") en el abordaje de la patología biliar complicada, siendo su uso sistemático. La asociación entre alteraciones de parámetros humorales y el cístico dilatado resulta un parámetro con alto valor predictivo para la presencia de litiasis coledociana.


ABSTRACT Background: Nowadays, the prevalence of gallstones ranges between 10 and 20% in Western world, and 7-16% of the patients also present choledocholithiasis. The preoperative diagnosis of choledocholithiasis is difficult. Objective: To establish our experience in the evaluation of complicated gallstone disease and two-stage management of choledochal lithiasis as standard or care. Material and methods: This prospective and observational study included patients hospitalized with gallstone disease undergoing procedures in the Department of General Surgery of Hospital Vidal from June 30, 2019, to December 30, 2019. Results: Ultrasound of the liver, biliary tract and pancreas was specific, with accuracy of 80.9% and sensitivity of 50%. Magnetic resonance cholangiopancreatography (MRCP) had a sensitivity of 100%, accuracy of 84.6% and sensitivity of 67%. As for endoscopic retrograde cholangiopancreatography (ERCP), the diagnosis of choledocholithiasis was made in 100% of the cases during the first cholangiography while "control" cholangiography had a sensitivity of 0%, specificity of 100% and accuracy of 15.4%. The presence of a dilated cystic duct intraoperatively in association with abnormal biochemical parameters had a sensitivity of 100%, specificity of 90%, and accuracy of 93.6%. Conclusion: Intraoperative cholangiography (IOC) is the gold standard procedure for the management of complicated gallstone disease. The association of biochemical parameters and a dilated cystic duct has high predictive value for choledochal lithiasis.


Subject(s)
Humans , Male , Female , Biliary Tract , Cholangiography , Lithiasis , Pancreas , Pathology , General Surgery , Magnetic Resonance Spectroscopy , Cholelithiasis , Gallstones , Cholangiopancreatography, Endoscopic Retrograde , Bile Ducts, Extrahepatic , Cystic Duct , Choledocholithiasis/complications , Cholangiopancreatography, Magnetic Resonance , Liver , Methods
5.
Rev. argent. cir ; 113(2): 224-228, jun. 2021. graf
Article in Spanish | LILACS, BDNPAR | ID: biblio-1365477

ABSTRACT

RESUMEN Antecedentes: los avances en cuidados perioperatorios e inmunosupresión permitieron que la su pervivencia de los pacientes trasplantados aumente significativamente, así observamos que la litiasis vesicular es más frecuente en este grupo de pacientes. Objetivo: el objetivo de este trabajo es analizar y describir los resultados obtenidos en colecistecto mías en pacientes trasplantados cardíacos. Material y métodos: seleccionamos los pacientes mediante una búsqueda cruzada entre las bases de datos de Trasplante Cardíaco y Cirugía Biliar. Recopilamos información sobre sus antecedentes médi cos, parámetros clínicos y de laboratorio, entre otros. Resultados: entre enero 1994-diciembre 2017 se realizaron 154 trasplantes cardíacos con una edad media de 40 años; 16 pacientes fueron incluidos en este estudio y en los cuales fue realizada la cole cistectomía laparoscópica posterior al trasplante. No se registraron morbilidad, readmisiones ni mor talidad. Conclusión: la colecistectomía laparoscópica es segura y es el método de elección en pacientes tras plantados cardíacos. Se debe realizar colangiografía intraoperatoria, ya que los predictores de litiasis coledociana suelen estar alterados.


ABSTRACT Background: The advances in perioperative care and immunosuppressive treatment resulted in a significant increase in survival of transplant patients; as a result, cholelithiasis is more common in transplant patients. Objective: The aim of this study is to analyze and describe the results obtained in cholecystectomies in heart transplant patients. Material and methods: We selected patients by cross-referencing the databases of heart transplantation and scheduled biliary surgeries, and collected information on their medical history, clinical parameters and laboratory tests, among other data. Results: Between January 1994 and December 2017, 154 heart transplant procedures were performed; mean age was 40 years; 16 underwent laparoscopic cholecystectomy after heart transplantation and were included in this study. There were no complications, readmissions or deaths. Conclusion: Laparoscopic cholecystectomy is safe and is the method of choice for heart transplant patients with cholelithiasis. Intraoperative cholangiography should be performed as the predictors of choledocholithiasis are usually abnormal.


Subject(s)
Humans , Male , Heart Transplantation , Cholecystectomy, Laparoscopic/methods , Perioperative Care/methods , Cystectomy , Immunosuppression Therapy , Transplants , Choledocholithiasis , Alkalies , Heart
6.
Rev. colomb. gastroenterol ; 36(supl.1): 59-62, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251548

ABSTRACT

Resumen Presentamos el caso de un paciente de 68 años, sin antecedentes de importancia, que por su cuadro clínico y resultados paraclínicos fue clasificado con riesgo intermedio para coledocolitiasis. En efecto, por medio de colangiorresonancia se realizó el diagnóstico confirmatorio. Fue llevado a colangiopancreatografía retrograda endoscópica en dos ocasiones -la primera fallida por papila intradiverticular-; en el segundo intento (exitoso con extracción del lito), el paciente presentó evolución posprocedimiento tórpida, con marcado dolor abdominal y anemización. Fue llevado a tomografía de abdomen con contraste, la cual confirmó el diagnóstico de hematoma subcapsular. Se decidió implementar el manejo conservador y se logró un control adecuado del sangrado.


Abstract This is the case of a 68-year-old female patient, with no relevant history, who was classified as intermediate risk for choledocholithiasis due to her symptoms and lab test results. The diagnosis was confirmed by means of cholangioresonance. She was taken to ERCP on two occasions; the first failed due to intradiverticular papilla, and during the second attempt (successful with the removal of the stone), the patient had a torpid post-procedure evolution, with marked abdominal pain and anemization. An abdominal tomography with contrast was performed, which confirmed the diagnosis of subcapsular hematoma. A conservative management was implemented, achieving adequate bleeding control.


Subject(s)
Humans , Male , Aged , Cholangiopancreatography, Endoscopic Retrograde , Hematoma , Choledocholithiasis , Hemorrhage , Methods
7.
Rev. argent. cir ; 113(1): 62-72, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1288175

ABSTRACT

RESUMEN Antecedentes: la prevalencia conjunta de litiasis vesicular y coledociana aumenta con la edad y llega al 15% en la octava década de la vida. Su manejo continúa siendo controvertido: algunos profesionales prefieren el abordaje en un tiempo por videolaparoscopia, y otros, el abordaje en dos tiempos con endoscopia (CPRE preoperatoria) seguida de colecistectomía laparoscópica. Objetivo: evaluar la eficacia y seguridad del manejo en un tiempo por videolaparoscopia en pacientes consecutivos con diagnóstico de litiasis vesicular y coledociana. Material y métodos: estudio retrospectivo con datos de una base de datos prospectiva, entre julio de 2008 y julio de 2018. Resultados: sobre un total de 2447 colecistectomías laparoscópicas realizadas en el citado período, 416 (17%) presentaron litiasis coledociana. El éxito global de la vía transcística en la extracción de litiasis coledociana fue del 81,2%: del 70,4% en los casos con diagnóstico prequirúrgico de colestasis extrahepática litiásica y del 92,9% en los otros diagnósticos. La morbilidad fue del 4%, sin mortalidad ni lesiones quirúrgicas de la vía biliar. Conclusión : el manejo en un tiempo por videolaparoscopia es eficaz y seguro debido al elevado éxito global de la instrumentación transcística (ITC). El diagnóstico preoperatorio de coledocolitiasis condi ciona una disminución de esa eficacia, por mayor indicación de coledocotomía, con un aumento de la morbilidad y del tiempo de internación.


ABSTRACT Background: The prevalence of common bile duct stones associated with cholelithiasis increases with age and is about 15 % in the 8th decade of life but its management is still controversial. Some surgeons prefer the single-stage approach with laparoscopy while others suggest the two-stage management with preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy. Objective: The aim of the present study was to evaluate the efficacy of feasibility of single-stage laparoscopic surgery in patients with cholelithiasis and choledocholithiasis. Material and methods: We conducted a retrospective study with prospectively collected data between July 2008 and July 2018. Results: Of 2447 laparoscopic cholecystectomies performed during the study period, 416 presented common bile duct stones. The global success of the transcystic approach to clear common bile duct stones was 81.2%, 70.4% in the cases with preoperative diagnosis of choledocholithiasis and 92.9% for other diagnoses. The rate of complications was 4% without deaths or bile duct injuries. Conclusion: Single-stage laparoscopic surgery is an efficient and safe approach based on the high global success of transcystic exploration. The preoperative diagnosis of choledocholithiasis reduces the efficacy of the procedure due to greater indication of choledocotomy, with complications and longer length of hospital stay.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy, Laparoscopic , Laparoscopy , Cholelithiasis , Efficacy , Retrospective Studies , Choledocholithiasis , Endoscopy
8.
Rev. colomb. cir ; 36(2): 301-311, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1223994

ABSTRACT

Introducción. La coledocolitiasis es la presencia de cálculos en las vías biliares. En la mayoría de los casos se trata mediante la colangio pancreatografía retrógrada endoscópica y menos comúnmente por intervención quirúrgica laparoscópica. El objetivo de este estudio fue describir una cohorte retrospectiva de pacientes sometidos a exploración laparoscópica de la vía biliar. Métodos. Se incluyeron pacientes intervenidos entre los años 2014 y 2018, en dos instituciones de nivel III en Cali, Colombia, referidos para valoración por cirugía hepatobiliar, por dificultad para la extracción de los cálculos por colangio pancreatografia retrograda endoscópica, debido al tamaño, la cantidad, o la dificultad para identificar o canular la papila duodenal. Resultados. De los 100 pacientes incluidos, se encontró que el 72 % fueron mujeres, con rango de edad entre 14 y 92 años. Al 39 % de los pacientes se les extrajo un solo cálculo y al 16 % 10 cálculos. Un 12 % presentaron cálculos gigantes (mayores de 2,5 cm de ancho) y un 44 % presentaron litiasis múltiple. Al 69 % de los pacientes se les realizó colecistectomía. El porcentaje de éxito de limpieza de la vía biliar por laparoscopia fue del 95 %.Discusión. La exploración laparoscópica de la vía biliar es una técnica posible, reproducible, segura y con excelentes resultados para el manejo de la coledocolitiasis


Introduction. Choledocholithiasis is the presence of stones in the bile ducts. In most cases it is treated by endoscopic retrograde cholangio pancreatography and less commonly by laparoscopic surgery. The objective of this study was to describe a retrospective cohort of patients who underwent laparoscopic exploration of the bile duct.Methods. The study included patients operated between 2014 and 2018, in two level III institutions in Cali, Colombia, referred for evaluation for hepato-biliary surgery, due to difficulty in removing stones by endoscopic retrograde pancreatography cholangiography, due to the size, quantity, or difficulty of identifying or cannulating the duodenal papilla. Results. Out of the 100 patients included, it was found that 72% were women, with an age range between 14 and 92 years. A single stone was removed from 39% of patients and 10 stones from 16%; 12% had giant stones (greater than 2.5 cm wide), and 44% had multiple stones; 69% of the patients underwent cholecystectomy. Laparoscopic bile duct cleaning success rate was 95%. Discussion. Laparoscopic exploration of the bile duct is a possible, reproducible, and a safe technique with excellent results for the management of choledocholithiasis


Subject(s)
Humans , Common Bile Duct , Minimally Invasive Surgical Procedures , Cholangiopancreatography, Endoscopic Retrograde , Laparoscopy , Choledocholithiasis
9.
ABCD arq. bras. cir. dig ; 34(3): e1607, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1355524

ABSTRACT

ABSTRACT Background: Retrograde endoscopic cholangiopancreatography (ERCP) effectively treats biliary and pancreatic disorders. Its indications are limited and precise, since its misuse delays adequate treatment, increases costs and to patient´s adverse events. Aim: To compare clinical, radiological and exploratory characteristics in relation to therapeutic success in patients undergoing ERCP in relation to age. Method: 421 patients who underwent the method were retrospectively studied; those who were not able to access the duodenal papilla were excluded. The patients were divided into two age groups: <60 years (group 1) and >60 years (group 2), and the variables of gender, examination indications, radiological findings, therapeutic success, diagnosis and the occurrence of immediate adverse events were analyzed. Results: 177 patients were allocated to group 1 and 235 to group 2. The main indication found in both groups was choledocholithiasis. In group 2, the number of cases of acute cholangitis (p=0.001), biliary stenosis (p=0.002) and papilla cancer (p=0.046) was higher. In this group, urgent indication for ERCP was higher (p=0.042), as well as the diagnosis of biliary tract dilatation (p<0.001). The placement of prostheses was the most common procedure performed in both groups, but the greatest number of patients in absolute quantity occurred in group 2. In group 1, the success in catheterization and the chance of achieving clearing of the biliary tract was significantly higher in compared to group 2 (p=0.016, OR=2.1). Conclusion: The success of catheterization and complete clearance of the bile duct was significantly higher in the group of young patients.


RESUMO Racional: A colangiopancreatografia endoscópica retrógrada (CPRE) trata eficazmente afecções biliares e pancreáticas. Suas indicações são limitadas e precisas, uma vez que seu uso indevido atrasa o tratamento adequado, aumenta os custos e submete pacientes a eventos adversos. Objetivo: Comparar as características clínicas, radiológicas e exploratórias em relação ao sucesso terapêutico em pacientes submetidos à CPRE com relação à idade. Método: Foram estudados retrospectivamente 421 pacientes submetidos ao método sendo excluídos aqueles onde não foi possível ao acesso a papila duodenal. Os pacientes foram divididos em dois grupos etários: <60 anos (grupo 1) e >60 anos (grupo 2) e analisadas as variáveis gênero, indicações do exame, achados radiológicos, sucesso terapêutico, diagnóstico e a ocorrência de eventos adversos imediatos. Resultados: 177 pacientes foram alocados no grupo 1 e 235 no grupo 2. A principal indicação encontrada em ambos os grupos foi coledocolitíase. No grupo 2, o número de casos de colangite aguda (p=0,001), estenose biliar (p=0,002) e neoplasia de papila (p=0,046) foi superior. Nesse grupo a indicação da CPRE em caráter de urgência foi superior (p=0,042), bem como o diagnóstico de dilatação da via biliar (p<0,001). A colocação de próteses foi o procedimento mais comumente realizado nos dois grupos, mas o maior número de doentes em quantidade absoluta ocorreu no grupo 2. No grupo 1, o sucesso na cateterização e a chance de conseguir o clareamento da via biliar foi significativamente superior em relação ao grupo 2 (p=0,016, OR=2,1). Conclusão: O sucesso da cateterização e o clareamento completo da via biliar foi significativamente superior no grupo de pacientes jovens.


Subject(s)
Humans , Biliary Tract , Cholestasis , Choledocholithiasis , Retrospective Studies , Cholangiopancreatography, Endoscopic Retrograde , Middle Aged
11.
Rev. colomb. gastroenterol ; 35(3): 269-279, jul.-set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138783

ABSTRACT

Resumen Introducción: la coledocolitiasis (CLDL) puede ser difícil de diagnosticar. Su importancia radica en sus potenciales complicaciones y en que el tratamiento se realiza mediante colangiopancreatografía retrógrada endoscópica (CPRE), un procedimiento con riesgo de generar complicaciones. Se han propuesto guías para su diagnóstico y la más empleada es la de la ASGE (American Society for Gastrointestinal Endoscopy), cuyo rendimiento no es ideal. Recientemente, se ha publicado la guía británica. Este estudio se realizó para establecer el rendimiento de ambas guías. Materiales y métodos: estudio prospectivo realizado entre agosto 1 de 2017 y julio 31 de 2018. Resultados: se incluyeron 300 pacientes para el análisis. Se realizó una CPRE en 145 pacientes y se confirmó la existencia de CLDL en 124 de ellos (85,5 %). La mediana de aspartato aminotransferasa (AST) y alanina aminotransferasa (ALT) fue mayor en los que tuvieron CLDC (207 mg/dL y 290 mg/dl, respectivamente). Entre tanto, la tasa de complicaciones posteriores a la CPRE fue del 5,5 %. El análisis multivariado no encontró una asociación significativa para alguna variable predictora de CLDL. En pacientes con alta probabilidad, las guías británicas tuvieron una sensibilidad del 65 % y una especificidad del 33 %, mientras que las guías ASGE mostraron una sensibilidad del 74 % y una especificidad del 28 %. En probabilidad intermedia fueron menos eficientes. Conclusiones: los criterios de la ASGE y la BSG (British Society of Gastroenterology) no tienen un buen desempeño en la población estudiada, a fin de discriminar la existencia o no de CLDL. La guía de la ASGE mostró un mejor rendimiento en general que las guías británicas.


Abstract Introduction: Choledocholithiasis (CDL) may be difficult to diagnose. The relevance of making a timely diagnosis lies in its potential negative effects and the fact that treatment requires performing endoscopic retrograde cholangiopancreatography (ERCP), which is a procedure with a high risk of complications. Several guidelines have been proposed for its diagnosis, including the ASGE Guidelines, which are the most widely used although they do not have an ideal performance, and the guidelines recently published by the BSG. The objective of this study was to compare the performance of both guidelines. Materials and methods: Prospective study carried out between August 1, 2017, and July 31, 2018. Results: 300 patients were included for analysis. 145 underwent ERCP and choledocholithiasis was confirmed in 124 of them (85.5%). Median AST and ALT levels were higher in patients with choledocholithiasis (207 mg/dL and 290 mg/dL). The rate of post-ERCP complications was 5.5%. Multivariate analysis found no significant association for any predictor of CDL. Regarding the "high probability" score, the BSG guidelines had sensitivity of 65% and specificity of 33%, while the ASGE guidelines had sensitivity of 74% and specificity of 28%. Both guidelines were less efficient for "intermediate probability". Conclusions: The ASGE and BSG criteria do not perform well in the population studied to determine whether they had CDL. The ASGE guidelines had a better overall performance than the BSG guidelines.


Subject(s)
Humans , Choledocholithiasis , Diagnosis , Multivariate Analysis , Prospective Studies , Sensitivity and Specificity , Cholangiopancreatography, Endoscopic Retrograde
12.
Rev. colomb. gastroenterol ; 35(3): 304-310, jul.-set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138787

ABSTRACT

Resumen Introducción: la patología biliar litiásica es una de las entidades más frecuentes en el área de cirugía general y en gastroenterología. El tratamiento varía según el lugar donde se alojen los cálculos. Para esto, se han definido diversas escalas de estratificación del riesgo de presentar coledocolitiasis, pero son los criterios planteados por la Sociedad Americana de Endoscopia Gastrointestinal (American Society for Gastrointestinal Endoscopy, ASGE) los más usados a nivel mundial, ya que tienen una precisión diagnóstica definida del 70 %. Los procedimientos o ayudas diagnósticas establecidas por estos criterios, en ocasiones, prolongan el tiempo de hospitalización, aumentan los costos y pueden tener complicaciones. Metodología: se realizó un estudio observacional analítico, de tipo transversal retrospectivo, con datos obtenidos a partir de las historias clínicas de pacientes sometidos a colecistectomía laparoscópica, en la Clínica CES de Medellín, entre julio y diciembre de 2017. Resultados y conclusiones: se analizaron 424 historias clínicas de pacientes sometidos a colecistectomia laparoscópica. De ellos, 254 (56,76 %) se categorizaron como de riesgo bajo, mientras que 94 (22,11 %) fueron de riesgo intermedio y 76 (17,88 %) de riesgo alto. Se encontró una frecuencia de coledocolitiasis del 90,8 % en aquellos categorizados como de riesgo alto y del 26,6 % en los pacientes de riesgo intermedio. En la categoría de riesgo intermedio se hallaron diferencias estadísticamente significativas entre ambos grupos para los valores de bilirrubina total, bilirrubina directa y aspartato aminotransferasa (AST) (p = 0,001; p = 0,014; p = 0,007, respectivamente). La baja frecuencia de coledocolitiasis en la categoría de riesgo intermedio puede ser explicada por cálculos menores a 5 mm no visibles en la colangiorresonancia. A partir de este estudio, se propone ajustar los rangos de valores de los criterios de la ASGE para la categoría de riesgo intermedio, permitiendo tener una mayor precisión a la hora de clasificar los pacientes con patología litiásica y disminuir costos y estancia hospitalaria.


Abstract Introduction: Biliary lithiasis is one of the most frequent diseases in the area of general surgery and gastroenterology. Treatment varies depending on the location of the gallstones. Several stratification scales of the risk of choledocholithiasis have been defined, being the criteria proposed by the American Society of Gastrointestinal Endoscopy (ASGE) the most used worldwide, with a diagnostic accuracy of 70%. However, the procedures or diagnostic aids defined by these criteria, sometimes, increase hospital stay, costs, and may lead to the development of complications. Methodology: An observational, analytical, retrospective, cross-sectional study was conducted with data obtained from the clinical records of patients undergoing laparoscopic cholecystectomy at the CES Clinic in Medellín, Colombia, between July and December of 2017. Results and conclusions: 424 medical records were analyzed, of which 254 (56.76%) were classified as low-risk, 94 (22.11%) as intermediate-risk and 76 (17.88%) as high-risk. The frequency of choledocholithiasis was 90.8% in high-risk patients and 26.6% in intermediate-risk patients. For the intermediate-risk category, statistically significant differences were found between the two groups for the total bilirubin, direct bilirubin, and AST values (p: 0.001, p: 0.014, p:0.007, respectively). The low frequency of choledocholithiasis in the intermediate-risk category can be explained by less than 5mm gallstones not identified by the cholangioresonance. Based on this study, we propose to adjust the ranges of the ASGE criteria variables for the intermediate-risk category for better accuracy when classifying patients with biliary lithiasis and, thus, reduce costs and hospital stay.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Disease , Cholecystectomy, Laparoscopic , Choledocholithiasis , Patients , Aspartate Aminotransferases , Bilirubin , Risk , Cross-Sectional Studies , Lithiasis
13.
Rev. colomb. gastroenterol ; 35(3): 319-328, jul.-set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138789

ABSTRACT

Resumen Introducción: la coledocolitiasis (CDL) afecta al 10 % de los pacientes con cálculos en la vesícula biliar. La obstrucción del colédoco se asocia a pancreatitis, colangitis y ruptura del colédoco. Clásicamente, la obstrucción biliar es considerada cuando se aumentan la fosfatasa alcalina, la γ-glutamil-transpeptidasa (GGTP) y las bilirrubinas. En la última década, se ha encontrado que hasta un 10 % de los pacientes con CDL presentan elevaciones de las aminotransferasas. En Latinoamérica, no se ha estudiado esta alteración. El objetivo del presente trabajo fue determinar la prevalencia de la elevación de transaminasas y su evolución. Metodología: estudio de casos y controles. Se determinó la alanina aminotransferasa (ALT) al ingreso, a las 48 h y a las 72 h. Si la ecografía era normal, se realizó una colangiorresonancia o una ecoendoscopia, así como una colangiopancreatografía retrógrada endoscópica (CPRE) cuando fue necesario. Resultados: se incluyeron 72 pacientes con CDL (casos) y 128 con colecistitis, sin CDL (controles). En los casos, el 83 % tuvo un aumento de ALT, mientras que el 56,9 % presentó una elevación de 2-9 veces, el 16 %, de 10-20 veces, y el 8,3 % mostró una elevación >20 veces. En contraste, a las 48 h, las ALT descendieron al 30 % y a las 72 h al 56 %. Entre tanto, en los controles hubo un aumento de ALT en el 27,3 %, mientras que en el 15,6 % se observó una elevación de 2-9 veces, en el 7,8 %, de 10-20 veces, y >20 veces en el 2,9 %. La combinación de cólico biliar y la elevación de ALT tuvo un valor predictivo positivo (VPP) para CDL del 72 %, así como un valor predictivo negativo (VPN) del 87,7 %. Conclusión: cuando hay un cólico biliar y una elevación de ALT es imperativo descartar una CDL, y si la ecografía es normal, es necesario realizar una colangiorresonancia o una ecoendoscopia biliopancreática.


Abstract Introduction: Choledocolithiasis (CLD) affects 10% of patients with gallstones. Bile duct obstruction is associated with pancreatitis, cholangitis, and rupture of the common bile duct. This condition usually presents with increased alkaline phosphatase, GGTP and bilirubin levels. In the last decade, it has been found that up to 10% of patients with CLD have elevated aminotransferases levels. In Latin America, this alteration has not been studied. The aim of the present work was to determine the prevalence of transaminase elevation and its evolution. Methodology: Case-control study. ALT was measured on admission, at 48 h and at 72 h. If ultrasound was normal, MRCP and/or echo-endoscopy and ERCP were performed, as appropriate. Results: A total of 72 patients with choledocholithiasis (CLD) (cases) and 128 with cholecystitis without choledocholithiasis (controls) were included. Among the cases, 83% had increased ALT levels, which was 2-9 times higher in 56.9%, 10-20 times higher in 16%, and more than 20 times higher in 8.3%. At 48 hours, those levels decreased by 30% and at 72 hours by 56%. In turn, in 27.3% of the controls, ALT was 2-9 times higher in 15.6%, 10-20 times higher in 7.8% and more than 20 times higher in 2.9%. The combination of biliary colic and ALT elevation had a positive predictive value (PPV) for CLD of 72% and a negative predictive value (NPV) of 87.7%. Conclusion: When biliary colic and ALT elevation are reported, it is imperative to rule out choledocholithiasis. If the ultrasound is normal, MRCP and/or biliopancreatic endoscopy should be performed.


Subject(s)
Humans , Case-Control Studies , Cholangiopancreatography, Endoscopic Retrograde , Lifting , Choledocholithiasis , Diagnosis , Alanine Transaminase , Transaminases , Colic , Endosonography
14.
Rev. colomb. gastroenterol ; 35(3): 382-389, jul.-set. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138798

ABSTRACT

Resumen El tratamiento de la coledocolitiasis ha evolucionado de forma significativa desde que Robert Abbe realizó la primera coledocotomía y la exploración de las vías biliares en Nueva York, en 1889. La colangiopancreatografía retrógrada endoscópica (CPRE), que inicialmente fue un método diagnóstico, ahora solo tiene validez como método terapéutico. En la actualidad, los principales métodos diagnósticos son la colangioresonancia magnética (CRM) y la ultrasonografía endoscópica (USE). El tratamiento de la coledocolitiasis pasó de la técnica quirúrgica abierta -en la que, de forma rutinaria, se realizaba la coledocorrafia sobre un tubo de Kehr o tubo en T- a la endoscópica, mediante el uso de la CPRE, la esfinteroplastia y la instrumentación con balones y canastilla. Hoy en día se dispone de técnicas adicionales como la litotricia mecánica (LM) o extracorpórea, la dilatación con balón (DB) de gran tamaño y el Spyglass ® . La técnica laparoscópica se usa desde hace varios años, en diversas partes del mundo, para el tratamiento de la coledocolitiasis. Estudios recientes proponen incluso el cierre primario del colédoco o la coledocoduodenostomía, con lo cual no sería necesaria la utilización del tubo en T. Pero en muchos otros sitios, y por diversas razones, se continúa usando la exploración quirúrgica abierta y el tubo en T, que representa una importante opción en el tratamiento de algunos pacientes. Caso clínico: paciente masculino de 88 años, con coledocolitiasis recidivante, cálculo gigante de difícil manejo endoscópico y sepsis de origen biliar, que requirió drenaje quirúrgico abierto de urgencias. Se realizó una coledocotomía, y se dejó el tubo en T. Posteriormente, se efectuó un tratamiento exitoso conjunto, mediante instrumentación por el tubo en T, por parte de cirugía general, y CPRE, por gastroenterología.


Abstract The treatment of choledocholithiasis has evolved significantly since Robert Abbé performed the first bile duct exploration via choledochotomy in New York in 1889. Endoscopic retrograde cholangiopancreatography (ERCP), which was initially used for diagnosis, is now only valid as a therapeutic tool. Currently, the main diagnostic methods are magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). The treatment of choledocholithiasis moved from the open surgery in which biliary stenting was routinely performed on a Kehr tube or T-tube, to the endoscopic technique using ERCP, sphincteroplasty and instrumentation with balloons and baskets. Additional techniques are now available such as mechanical or extra-corporeal lithotripsy, endoscopic papillary large balloon dilation and SpyGlass cholangioscopy. The laparoscopic technique has been used for several years in different parts of the world for the treatment of choledocholithiasis. Recent studies even propose performing the primary closure of the bile duct or choledochoduodenostomy, so that the T-tube is not necessary. However, in many other places, and for a variety of reasons, open exploratory surgery and the T-tube continue to be used, being an important option in the treatment of some patients. Case presentation: 88-year-old male patient with recurrent choledocholithiasis and a giant gallstone that was difficult to treat endoscopically, with sepsis of biliary origin, which required open surgical drainage at the emergency room. Choledocotomy was performed, and a T-tube was inserted at the site. Subsequently, a successful joint treatment was performed by the General Surgery Service and the Gastroenterology Service, using T-tube instrumentation and ERCP, respectively.


Subject(s)
Humans , Male , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , General Surgery , Bile Ducts , Choledochostomy , Mechanics
15.
Prensa méd. argent ; 105(3): 138-139, may 2019.
Article in Spanish | LILACS, BINACIS | ID: biblio-1025433

ABSTRACT

The term choledocholithiasis refers to a condition when a gallstone or gallstones become lodged within any duct of the bile system. We can find pigment gallstones, cholesterol gallstones and mixed. During surgery to remove the gallbladder you may have a procedure called intraoperative cholangiogram to look for gallstones that may be in the common bileduct. Stones in the bile ducts are classified as either primary (arising the novo), secondary (migrating from the gallbladder), recurrent (reforming after biliary tract surgery) or retained (overlooked at the time of surgery). The prevalence of choledocholithiasis in patients with simptomatic gallbladder lithiasis can be a reason for enlargement of the hospital stay, and eventually in the complexity on the prevented surgical procedure. Our aim was to investigate its prevalence in our Hospital, and the results with the empoyement of the intraoperative cholangiography accordin to our surgical protoco, and the recognized guideliness from other Centers. The results obtained are discused


Subject(s)
Humans , Cholangiography/instrumentation , Gallstones/complications , Retrospective Studies , Choledocholithiasis/complications , Electronic Health Records/statistics & numerical data , Length of Stay/statistics & numerical data
16.
Rev. argent. cir ; 111(1): 15-19, mar. 2019. graf, tab
Article in Spanish | LILACS | ID: biblio-1003255

ABSTRACT

Antecedentes: la demora en el tratamiento de la litiasis vesicular sintomática (LVS) aumenta el riesgo de complicaciones biliares. Se plantea la hipótesis de que existen diferencias en el tratamiento de la LVS entre el sector público y el de obras sociales del Gran Buenos Aires (GBA). Objetivo: comparar la proporción de pacientes con litiasis biliar complicada (LBC) que presentaban diagnóstico previo de LVS, y evaluar la historia previa de la LBC según la presencia de síntomas y la relación con el sistema de salud. Material y métodos: estudio de corte transversal comparativo entre un hospital público (HPu) y otro privado (HPr) del GBA. Se analizó la historia clínica y se realizó una encuesta a pacientes colecistectomizados por LBC (colecistitis aguda, pancreatitis aguda y coledocolitiasis). Resultados: se incluyeron 105 pacientes del HPu y 136 del HPr. Las características basales difirieron en la edad, nivel educativo, distancia domicilio-hospital y ASA. El diagnóstico previo de LVS fue más frecuente en el HPu (60% vs. 39,7%; p = 0,02), diferencia que se mantuvo luego del ajuste multivariable (OR 2,14; IC 95%: 1,1 a 4,1; p = 0,02). Los pacientes del HPu mostraron una mayor frecuencia de dolores abdominales, tiempo desde el diagnóstico, número de consultas de urgencia luego del diagnóstico y mayor tiempo en lista de espera. Conclusiones: ell HPu mostró mayor pérdida de oportunidad quirúrgica de la litiasis vesicular en un estadio previo no complicado. Las causas podrían ser multifactoriales, pero se necesitan más estudios para corroborar esta hipótesis.


Background: Delays in the treatment of symptomatic cholelithiasis (SCL) increases the risk of biliary complications. There may be differences in the treatment of SCL between the public sector and the social security in the Greater Buenos Aires (GBA). Objectives: The aim of this study was to compare the proportion of patients with complicated gallstone disease (CGD) with previous diagnosis of SCL and to evaluate the history of CGD according to the presence of symptoms and its relation with the health care system. Material and methods: We conducted a cross-sectional study comparing a public hospital (PH) versus a private center (PrH) in the GBA. The clinical records were analyzed and patients with a history of cholecystectomy due to CGD (acute cholecystitis, acute pancreatitis and acute choledocholithiasis) were surveyed. Results: A total of 105 PH patients and 136 PrH patients were included. The baseline characteristics differed in terms of age, educational level, distance from home to hospital and ASA physical status classification. The previous diagnosis of SCL was more common in the PH (60% vs. 39.7%; p = 0.02) and this difference persisted after multivariate adjustment (OR 2.14; 95% CI, 1.1-4.1; p = 0.02). The PH presented more patients with abdominal pain and more visits to the emergency department (ED) after the diagnosis; time after the diagnosis was greater and these patients spent more time on the waiting list. Conclusions: The PH showed greater loss of surgical opportunity of uncomplicated cholelithiasis. This may be due to multiple factors, but further studies are necessary to confirm this hypothesis.


Subject(s)
Pancreatitis , Cholecystectomy , Choledocholithiasis , Cholecystolithiasis , Cholecystitis, Acute , Patients , Social Adjustment , Bereavement , Abdominal Pain , Cross-Sectional Studies , Causality , Classification , Diagnosis , Methods
17.
Rev. chil. cir ; 71(1): 47-54, feb. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-985378

ABSTRACT

Resumen Introducción: Existe una tendencia global al envejecimiento y con ello un aumento de patologías asociadas. En Chile la prevalencia de la colelitiasis o colecistolitiasis aumenta con la edad, siendo la cole-cistectomía una de las cirugías más frecuentes. Existen escasos estudios latinoamericanos referentes a la realidad de la población octogenaria expuesta a este problema. Objetivo: Estudiar la morbimortalidad posoperatoria en pacientes octogenarios operados de colecistectomía. Definir la precisión de distintas herramientas diagnósticas preoperatorias, estudiar variables operatorias y precisar costos hospitalarios. Materiales y Método: Estudio observacional retrospectivo de la ficha clínica electrónica del Hospital Clínico de la Universidad de Chile, entre enero de 2012 y mayo de 2017. Se incluyeron pacientes con edad igual o mayor a 80 años, en quienes se realizó una colecistectomía electiva o de urgencia por patología benigna. Resultados: Se incluyeron 145 pacientes, 51,7% fueron mujeres, el promedio de edad fue de 84,1 años y un 74,5% presentaba comorbilidades. El 62,1% de los casos ingresó por urgencia. 26,2% de toda la muestra presentó coledocolitiasis. La colecistectomía fue laparoscópica en 73,8% de la muestra global, la tasa de conversión fue de 14,5% en población de urgencia y 1,8% en población electiva (p = 0,009). La población operada totalmente por vía laparoscópica con coledocolitiasis fue resuelta en un 95,2% a través de Rendez-vous, con una tasa de éxito del 100%. La tasa de complicaciones fue de 17,9% siendo en su mayoría médicas, la mortalidad quirúrgica fue de 2,1%, siendo todos casos de urgencia. El costo promedio de atención en salud hospitalaria fue de $5.888.104 pesos chilenos (U$9.000). Conclusión: El paciente octogenario con colecistolitiasis representa un desafío quirúrgico, dado un mayor número de comorbilidades, un cuadro clínico más agresivo y una elevada tasa de coledocolitiasis. Es aconsejable valorar el abordaje mínimamente invasivo y realizar una colangiografía intraoperatoria de rutina.


Introduction: There is a global tendency to aging and associated pathologies. In Chile, the prevalence of cholecystolithiasis increases with age, cholecystectomy is one of the most frequent surgeries in the contry. There are few latinamerican studies regarding the reality of the elderly exposed to this problem. Objective: Study postoperative morbimortality in octogenarian patients undergoing cholecystectomy. Define the accuracy of different preoperative diagnostic tools, study operative variables and specify hospital costs. Materials and Method: Retrospective observational study of the Clinical Hospital of the University of Chile, between January 2012 and May 2017. Patients with age equal to or greater than 80 years were included, in whom an elective or emergency cholecystectomy was performed for benign pathology. Results: A total of 145 patients were included, 51.7% were women, the average age was 84.1 years, and 74.5% had comorbidities. The admission was throw the emergency department in 62.1% of the cases. Choledocholithiasis was diagnosed in 26.2% of the entire sample. Cholecystectomy was fully laparoscopic in 73.8% of the overall sample, the conversion rate was 14.5% in the emergency population and 1.8% in the elective population (p = 0.009). The population operated fully laparoscopically, that had choledocholithiasis, was resolved in 95.2% through Rendezvous technique, with a 100% clearance rate of common bile duct. The complication rate was 17.9%, most being medical. The surgical mortality was 2.1%, all cases operated from emergency. The average cost of hospital health care was $5,888,104.3 Chilean pesos (U$9.000). Conclusion: The octogenarian patient with cholecystolithiasis represents a surgical challenge, given a greater number of comorbidities, a more aggressive clinical setting and a high rate of choledocolithiasis. It is advisable to assess the minimally invasive approach and perform routine intraoperative cholangiography. In the postoperative period, the cardiopulmonary status and the infectious complications of the surgical site should be monitored closely.


Subject(s)
Humans , Male , Female , Aged, 80 and over , Choledocholithiasis/surgery , Choledocholithiasis/diagnosis , Choledocholithiasis/etiology , Gallstones/surgery , Retrospective Studies , Cholecystectomy, Laparoscopic , Laparoscopy/methods
18.
Rev. colomb. cir ; 34(1): 37-44, 20190000. tab
Article in Spanish | LILACS | ID: biblio-982073

ABSTRACT

Introducción. La coledocolitiasis de probabilidad intermedia es una condición con gran morbilidad por el riesgo de pancreatitis y colangitis, y se requiere el estudio de la vía biliar para su enfoque diagnóstico y terapéutico. Actualmente, el método de referencia para su diagnóstico y tratamiento, es un examen invasivo, la colangiopancreatografía retrógrada endoscópica (CPRE), que no siempre lleva a un diagnóstico positivo de coledocolitiasis, pero sí implica exponer a los pacientes a sus riesgos. Por esta razón, la colangiopancreatografía por resonancia magnética (CPRM) ha tomado importancia en el diagnóstico, ya que es un examen no invasivo y con menor riesgo de complicaciones, por lo que se pretende evaluar su uso en la coledocolitiasis de probabilidad intermedia. Métodos. Se llevó a cabo un estudio de pruebas diagnósticas en una muestra de pacientes con coledocolitiasis de probabilidad intermedia, en la Fundación Salud El Bosque, entre enero de 2012 y agosto de 2015. Resultados. Se incluyeron 151 pacientes con diagnóstico de coledocolitiasis de probabilidad intermedia. Se evaluaron las características de la CPRM, la cual mostró sensibilidad de 88 %, especificidad de 79 %, valor predictivo positivo (VPP) de 88 % y valor predictivo negativo (VPN) de 96 %, con un índice de exactitud de 94,7 %. Conclusiones. La CPRM es un examen con un rendimiento adecuado en la evaluación de los pacientes con coledocolitiasis de probabilidad intermedia. En estos casos permite obviar la CPRE diagnóstica. El impacto de la dilatación de la vía biliar sumada a otras alteraciones del perfil hepático, no se puede establecer con este estudio


Introduction. Patients with intermediate probability of choledocholithiasis exhibit a highly morbid pathology due to the risk of developing pancreatitis and cholangitis; it demands the study of the bile duct for appropriate diagnostic and therapeutic approach. Currently, the gold standard for its diagnosis and treatment is an invasive examination, ERCP, which not always ends with positive diagnosis of choledocholithiasis, exposing the patient to the associated risks. This is why magnetic resonance cholangiopancreatography has acquired importance in the diagnosis, for it is a non-invasive procedure with lesser risk of complications. For this reason we decided to evaluate its use in mid-probability choledocholithiasis. Methods. A study of the diagnostic tests was carried out in a sample of 151 patients with intermediate probability of choledocholithiasis at our center, Fundación Salud El Bosque (Bogotá, Colombia), in the period 2012-2015. Results: A total of 151 patients with the diagnosis of choledocholithiasis of intermediate probability were included, evaluating the characteristics of the MRCP, which showed sensitivity of 88%, specificity 79%, PPV88% and NPV 96%, with an accuracy index of 94.7%. Conclusions. MRCP is a test that exhibits adequate performance in the evaluation of patients with intermediate probability of choledocholithiasis, avoiding the performance of ERCP. It confirms its previous use when faced with mid-chance choledocholithiasis. The diagnostic impact of dilation of the bile duct and other alterations of the liver profile can not be established with this study


Subject(s)
Humans , Common Bile Duct , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , Cholangiopancreatography, Magnetic Resonance
19.
ABCD arq. bras. cir. dig ; 32(1): e1416, 2019. tab
Article in English | LILACS | ID: biblio-973382

ABSTRACT

ABSTRACT Background: Cholelithiasis is a highly prevalent condition, and choledocholitiasis is a high morbidity complication and requires accurate methods for its diagnosis. Aim: To evaluate the population of patients with suspected choledocholitiasis and check the statistical value of magnetic resonance cholangiopancreatography, ultrasonography, the laboratory and the clinic of these patients comparing them to the results obtained by perioperative cholangiography. Methods: This is a retrospective cohort study, which were evaluated 76 patients with cholelithiasis and suspected choledocholithiasis. Results: It was observed that the presence of dilatation of the biliary tract or choledocholithiasis in the ultrasonography was four and eight times increased risk of perioperative cholangiography for positive choledocholithiasis, respectively. For each unit increased in serum alkaline phosphatase was 0.3% increased the risk of perioperative cholangiography for positive choledocholithiasis. In the presence of dilatation of the bile ducts in the ultrasonography was four times greater risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. In the presence of pancreatitis these patients had five times higher risk of positive magnetic resonance cholangiopancreatography for choledocholithiasis. On the positive magnetic resonance cholangiopancreatography presence to choledocholithiasis was 104 times greater of positive perioperative cholangiography for choledocholithiasis. Conclusions: The magnetic resonance cholangiopancreatography is a method with good accuracy for propedeutic follow-up for the diagnosis of choledocholithiasis, consistent with the results obtained from the perioperative cholangiography; however, it is less invasive, with less risk to the patient and promote decreased surgical time when compared with perioperative cholangiography.


RESUMO Racional: A colelitíase é afecção de alta prevalência, sendo a coledocolitíase complicação de elevada morbidade e que necessita de métodos acurados para seu diagnóstico. Objetivo: Avaliar o perfil populacional de pacientes com suspeita de coledocolitíase e verificar o valor estatístico da colangiopancreatografia por ressonância magnética, da ultrassonografia, dos exames laboratoriais e da clínica desses pacientes e compará-los aos resultados obtidos pela colangiografia peroperatória. Métodos: Trata-se de estudo longitudinal, de coorte, retrospectivo, no qual foram avaliados 76 pacientes com diagnóstico de colelitíase e suspeita de coledocolitíase. Resultados: Observou-se que na presença de dilatação das vias biliares ou coledocolitíase na ultrassonografia havia risco quatro e oito vezes maior, respectivamente, de colangiografia peroperatória positiva para coledocolitíase. Para cada unidade de aumento na fosfatase alcalina sérica houve aumento em 0,3% no risco de colangiografia peroperatória positiva para coledocolitíase. Na presença de dilatação das vias biliares na ultrassonografia ou clínica de pancreatite havia risco quatro e cinco vezes maior, respectivamente, de colangiopancreatografia por ressonância magnética positiva para coledocolitíase. Na presença de colangiopancreatografia por ressonância magnética positiva para coledocolitíase o risco foi 104 vezes maior de colangiografia peroperatória positiva para coledocolitíase. Conclusão: A colangiopancreatografia por ressonância magnética para seguimento propedêutico tem boa acurácia para o diagnóstico de coledocolitíase, e concordante com os resultados obtidos na colangiografia peroperatória. O método é menos invasivo, com menores riscos ao paciente e com diminuição do tempo cirúrgico dispendido para realização da colangiografia peroperatória.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cholangiography/methods , Choledocholithiasis/diagnostic imaging , Cholangiopancreatography, Magnetic Resonance/methods , Pancreatitis/diagnostic imaging , Biliary Tract/diagnostic imaging , Cholecystectomy/methods , Logistic Models , Reproducibility of Results , Retrospective Studies , Risk Factors , Longitudinal Studies , Ultrasonography/methods , Sensitivity and Specificity , Statistics, Nonparametric , Risk Assessment , Choledocholithiasis/surgery , Dilatation, Pathologic/diagnostic imaging , Perioperative Period
20.
San Salvador; s.n; 2019. 25 p. graf.
Thesis in Spanish | LILACS, BISSAL | ID: biblio-1152158

ABSTRACT

La patología benigna de la vía biliar es un motivo de consulta frecuente en las unidades de emergencia del instituto salvadoreño del seguro social (ISSS); la litiasis biliar o colelitiasis es una de las afecciones más frecuentes, con reportes de hasta 10-20% de afectación en la población mundial muchas veces haciéndose acompañar de coledocolitiasis (migración de litos a la vía biliar principal o su formación in situ). El manejo endoscópico ha cambiado radicalmente el tratamiento de la coledocolitiasis con el advenimiento del CPRE (colangiopancreatografía endoscópica retrógrada), con beneficios para el diagnóstico y tratamiento de esta entidad. Por mucho tiempo se han discutido las indicaciones para la realización de este estudio; la American Society for Gastrointestinal Endoscopy, por sus siglas (ASGE), propuso una estrategia de abordaje clasificando a los pacientes en diferentes niveles de riesgo, siendo los de riesgo alto los que podrían beneficiarse más de un CPRE. En el ISSS no se aplica de forma rutinaria o protocolizada ninguna escala y muchos pacientes pueden ser sometidos a este procedimiento sin beneficio alguno, retardando en ocasiones el tratamiento definitivo algo que además implica costos para la institución. Es por esto que se planteó el presente estudio donde se identificó una clara relación entre la determinación de riesgo de coledocolitiasis a través de la escala de la ASGE, con el diagnóstico de la misma a través de CPRE, con un 70.39% de personas con estudio positivo clasificadas en RIESGO ALTO


Subject(s)
Choledocholithiasis , General Surgery
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