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1.
ABCD arq. bras. cir. dig ; 33(4): e1556, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152639

ABSTRACT

ABSTRACT Background: Hepatic artery thrombosis is an important cause of graft loss and ischemic biliary complications. The risk factors have been related to technical aspects of arterial anastomosis and non-surgical ones. Aim: To evaluate the risk factors for the development of hepatic artery thrombosis. Methods: The sample consisted of 1050 cases of liver transplant. A retrospective and cross-sectional study was carried out, and the variables studied in both donor and recipient. Results: Univariate analysis indicated that the variables related to hepatic artery thrombosis are: MELD (p=0.04) and warm time ischemia (p=0.005). In the multivariate analysis MELD=14.5 and warm ischemia time =35 min were independent risk factors for hepatic artery thrombosis. In the prevalence ratio test for analysis of the anastomosis as a variable, it was observed that patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Conclusions: Prolonged warm ischemia time, calculated MELD and recipient age were independent risk factors for hepatic artery thrombosis after liver transplantation in adults. Transplanted patients with continuous suture had an increase in thrombosis when compared to interrupted suture. Re-transplantation due to hepatic artery thrombosis was associated with higher recipient mortality.


RESUMO Racional: Trombose de artéria hepática é importante causa de falência de enxerto e complicações biliares. Fatores de risco para trombose estão relacionados aos aspectos técnicos da anastomose arterial e fatores não cirúrgicos. Objetivo: Avaliar os fatores de risco para o desenvolvimento de trombose de artéria hepática. Métodos: A amostra consta de 1050 casos de transplante hepático. Foi realizado estudo retrospectivo e transversal, e as variáveis foram avaliadas em doadores e receptores. Resultados: A análise univariada mostrou que as variáveis relacionadas a trombose de artéria hepática são: MELD e tempo de isquemia quente. Na análise multivariada, o MELD=14.5 e tempo de isquemia quente =35 min foram fatores de risco independentes para trombose de artéria hepática. No teste de prevalência para avaliação do tipo de anastomose como variável, foi observado que a sutura contínua tem maior risco de trombose quando comparada com aquela em pontos separados. Conclusão: Tempo de isquemia quente prolongado, MELD calculado e idade do recipiente foram fatores de risco independentes para trombose de artéria hepática após transplante de fígado em adultos. Pacientes submetidos à anastomose com sutura contínua apresentaram mais trombose quando comparados com a em pontos separados. Retransplante por trombose está associado com maior mortalidade.


Subject(s)
Humans , Adult , Thrombosis/etiology , Vascular Surgical Procedures/adverse effects , Liver Transplantation/adverse effects , Hepatic Artery/surgery , Vascular Surgical Procedures/methods , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Liver Transplantation/methods , Liver Diseases/surgery
2.
ABCD arq. bras. cir. dig ; 33(3): e1541, 2020. tab
Article in English | LILACS | ID: biblio-1141908

ABSTRACT

ABSTRACT Background - Biliary complications (BC) represent the most frequent complication after liver transplantation, up to 34% of cases. Aim: To identify modifiable risk factors to biliary complications after liver transplantation, essential to decrease morbidity. Method: Clinical data, anatomical characteristics of recipient and donors, and transplant operation features of 306 transplants with full arterial patency were collected to identify risk factors associated with BC. Results: BC occurred in 22.9% after 126 days (median) post-transplantation. In univariate analyses group 1 (without BC, n=236) and group 2 patients (with BC, n=70) did not differ on their general characteristics. BC were related to recipient age under 40y (p=0.029), CMV infection (p=0.021), biliary disease as transplant indication (p=0.018), lower pre-transplant INR (p=0.009), and bile duct diameter <3 mm (p=0.033). CMV infections occurred sooner in patients with postoperative biliary complications vs. control (p=0.07). In a multivariate analysis, only CMV infection, lower INR, and shorter bile duct diameter correlated with BC. Positive CMV antigenemia correlated with biliary complications, even when titers lied below the treatment threshold. Conclusions: Biliary complications after liver transplantation correlated with low recipient INR before operation, bile duct diameter <3 mm, and positive antigenemia for CMV or disease manifestation. As the only modifiable risk factor, routine preemptive CMV inhibition is suggested to diminish biliary morbidity after liver transplant.


RESUMO Racional: Complicações biliares (CB) são os eventos adversos mais frequentes após o transplante de fígado, ocorrendo em até 34% dos procedimentos. Objetivo: Identificar fatores de risco modificáveis para o aparecimento de complicações biliares após transplantes de fígado, essenciais para diminuir morbidade. Método: Investigação dos dados clínicos, características anatômicas de receptores e doadores e informações sobre a operação de 306 transplantes com artéria hepática pérvia, para identificar fatores de risco associados ao aparecimento de CB. Resultados: CB ocorreu em 22,9% após 126 dias (mediana) do transplante. Em análise univariada pacientes do grupo 1 (sem CB, n=236) e grupo 2 (com CB, n=70) não diferiram em suas características gerais. CB esteve relacionada à idade do receptor menor que 40 anos (p=0,029), infecção pelo citomegalovírus (CMV, p=0,021), doença biliar como indicação ao transplante (p=0,018), RNI pré-transplante mais baixo (p=0,009) e diâmetro do ducto biliar <3 mm (p=0,033). Infecções pelo CMV ocorreram mais precocemente em pacientes com CB (p=0,07). Na análise multivariada, somente infecção por ele, INR mais baixo e menor diâmetro do ducto biliar mantiveram correlação com CB. Antigenemia positiva para CMV correlacionou com CB mesmo em títulos inferiores ao cutoff para tratamento. Conclusões: CB após transplante hepático esteve relacionada com menores RNI do receptor antes da operação, diâmetro do ducto biliar <3 mm e antigenemia ou manifestação clínica positiva para CMV. Como único fator de risco evitável, tratamento preemptivo para inibição do CMV é sugerido para diminuir morbidade biliar após o transplante.


Subject(s)
Humans , Postoperative Complications/epidemiology , Bile Ducts/pathology , Liver Transplantation/adverse effects , Liver Diseases/surgery , Postoperative Complications/etiology , Retrospective Studies , Risk Factors
3.
Rev. cir. (Impr.) ; 71(5): 433-441, oct. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058297

ABSTRACT

Resumen Introducción: La cirugía laparoscópica es la vía de abordaje de elección para el tratamiento de múltiples patologías abdominales, sin embargo, su desarrollo en la cirugía hepato-bilio-pancreática (HBP) ha sido más lento y heterogéneo. Objetivo: Presentar los resultados de la implementación y desarrollo de un programa de cirugía HBP laparoscópica en el Hospital de Regional de Talca. Materiales y Método: Estudio de serie de casos que incluye a todos los pacientes operados por una patología HBP por vía laparoscópica como acceso a la cavidad abdominal en el Hospital Regional de Talca entre el 1 de junio de 2014 y el 30 de junio de 2016. Resultados: Fueron 42 pacientes, 25 (59,5%) de sexo femenino. La mediana de edad fue 58 años (IQ25-75 38-64 años). 22 (52,4%) tuvo una cirugía abdominal previa en la mayoría de ellos por vía abierta. 22 (52,4%) pacientes fueron intervenidos por patología maligna. La indicación más frecuente fue la cirugía radical por cáncer de vesícula biliar en 10 (23,8%) casos y la hidatidosis hepática (HH) en 7 (16,7%). 1 (2,4%) paciente portador de una HH requirió de una conversión a laparotomía. 5 (11,9%) presentaron alguna morbilidad posoperatoria, 2 de ellos > III de Clavien. La mediana de recuperación funcional fue de 1 día (1-2) y la de estadía posoperatoria de 3 días (3-4). No hubo mortalidad a 90 días. Con una mediana de seguimiento de 26,5 (18-33) meses, 4 (19%) de los 21 pacientes oncológicos intervenidos con intención curativa presentaron recurrencia de la enfermedad, la mayoría de ellos sistémica y el 95% está libre de recurrencia a los 24 meses. Conclusiones: La implementación y el desarrollo de la cirugía hepato-bilio-pancreática (HBP) por vía laparoscópica puede efectuarse en hospitales de referencia regional con los mismos estándares y resultados internacionales.


Introduction: Laparoscopic surgery is the preference access for the treatment of various abdominal pathologies, however, its development in hepato-biliary-pancreatic (HBP) surgery has been slower and heterogeneous. Aim: Present the results of the implementation and development of a laparoscopic HBP surgery program at the Regional Hospital of Talca. Materials and Method: Case series study in which were included all patients submitted to laparoscopic surgery for treatment of HPB pathology as access to the abdominal cavity in the Regional Hospital of Talca between June 1, 2014 and June 30, 2016. Results: There were 42 patients, 25 (59.5%) female. The median age was 58 years (IQ25-75 38-64 years). 22 (52.4%) had previous abdominal surgery in most of them by open route. 22 (52.4%) patients were operated on for malignant pathology. The most frequent indication was radical surgery for gallbladder cancer in 10 (23.8%) cases and hepatic hydatidosis (HH) in 7 (16.7%). 1 (2.4%) patient carrying a HH required a conversion to laparotomy. 5 (11.9%) presented some postoperative morbidity, 2 of them > Clavien III. The median functional recovery was 1 day (1-2) and the postoperative stay was 3 days (3-4). There was no mortality at 90 days. With a median follow-up of 26.5 (18-33) months, 4 (19%) of the 21 oncological patients operated on with curative intent presented recurrence of the disease, most of them systemic and 95% free from recurrence at 24 months. Conclusions: Implementation and development of HBP surgery by laparoscopy is feasible and it can be performed in regional referral hospitals with the same international standards and results.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Pancreatic Diseases/surgery , Biliary Tract Surgical Procedures/methods , Liver Diseases/surgery , Pancreatectomy/mortality , Postoperative Period , Biliary Tract Surgical Procedures/mortality , Chile , Treatment Outcome , Laparoscopy/methods , Recovery of Function , Hepatectomy/mortality
4.
Arq. gastroenterol ; 56(2): 165-171, Apr.-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1019446

ABSTRACT

ABSTRACT BACKGROUND: Liver transplantation (LTx) is the primary and definitive treatment of acute or chronic cases of advanced or end-stage liver disease. Few studies have assessed the actual cost of LTx categorized by hospital unit. OBJECTIVE: To evaluate the cost of LTx categorized by unit specialty within a referral center in southern Brazil. METHODS: We retrospectively reviewed the medical records of 109 patients undergoing LTx between April 2013 and December 2014. Data were collected on demographic characteristics, etiology of liver disease, and severity of liver disease according to the Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores at the time of LTx. The hospital bill was transformed into cost using the full absorption costing method, and the costs were grouped into five categories: Immediate Pretransplant Kit; Specialized Units; Surgical Unit; Intensive Care Unit; and Inpatient Unit. RESULTS: The mean total LTx cost was US$ 17,367. Surgical Unit, Specialized Units, and Intensive Care Unit accounted for 31.9%, 26.4% and 25.3% of the costs, respectively. Multivariate analysis showed that total LTx cost was significantly associated with CTP class C (P=0.001) and occurrence of complications (P=0.002). The following complications contributed to significantly increase the total LTx cost: septic shock (P=0.006), massive blood transfusion (P=0.007), and acute renal failure associated with renal replacement therapy (dialysis) (P=0.005). CONCLUSION: Our results demonstrated that the total cost of LTx is closely related to liver disease severity scores and the development of complications.


RESUMO CONTEXTO: O transplante hepático (TxH) é o principal e definitivo tratamento de casos agudos ou crônicos de doenças hepáticas avançadas ou terminais. Poucos estudos têm avaliado o custo real do TxH categorizado por setores hospitalares. OBJETIVO: Avaliar o custo do TxH categorizado por especialidade da unidade em um centro de referência na região sul do Brasil. MÉTODOS: Analisamos retrospectivamente os prontuários de 109 pacientes submetidos a TxH entre abril de 2013 e dezembro de 2014. Foram coletados dados sobre características demográficas, etiologia da doença hepática e gravidade da doença hepática de acordo com os escores Child-Turcotte-Pugh (CTP) e Model for End-stage Liver Disease (MELD) no momento do TxH. A conta hospitalar foi transformada em custo pelo método de custeio por absorção integral, e os custos foram agrupados em cinco categorias: Kit Pré-Transplante Imediato; Unidades Especializadas; Centro Cirúrgico; Unidade de Terapia Intensiva; e Unidade de Internação. RESULTADOS: O custo médio total do TxH foi de US$ 17.367. O Centro Cirúrgico, as Unidades Especializadas e a Unidade de Terapia Intensiva responderam por 31,9%, 26,4% e 25,3% dos custos, respectivamente. A análise multivariada demonstrou que o custo total do TxH se associou significativamente ao escore CTP classe C (P=0,001) e ao desenvolvimento de intercorrências (P=0,002). As seguintes intercorrências contribuíram para aumentar significativamente o custo do TxH: choque séptico (P=0,006), politransfusão sanguínea (P=0,007) e insuficiência renal aguda associada à terapia renal substitutiva (diálise) (P=0,005). CONCLUSÃO: Nossos resultados demonstraram que o custo total do TxH guarda uma estreita relação com os escores de gravidade da doença hepática e com o desenvolvimento de intercorrências.


Subject(s)
Humans , Male , Female , Adult , Aged , Liver Transplantation/economics , Liver Diseases/surgery , Brazil , Retrospective Studies , Liver Transplantation/adverse effects , Hospital Costs , Length of Stay , Liver Diseases/economics , Middle Aged
5.
ABCD arq. bras. cir. dig ; 32(4): e1463, 2019. tab, graf
Article in English | LILACS | ID: biblio-1054595

ABSTRACT

ABSTRACT Background: Primary intrahepatic lithiasis is defined when the stones are formed in the liver and associated with local dilatation and biliary stricture. Liver resection is the ideal procedure. Aim: To evaluate the results of liver resection in the treatment of non-oriental intrahepatic lithiasis. Methods: Fifty-one patients with symptomatic benign non-oriental hepatolithiasis underwent surgical resection in six institutions in Brazil. Demography data, clinical symptoms, classification, diagnosis, management and postoperative course were analyzed. Results: Of the 51 patients, 28 were male (54.9%), with a mean age of 49.3 years. History of cholangitis was observed in 15 (29.4%). The types of intrahepatic lithiasis were type I in 39 (76.5%) and type IIb in 12 (23.5%), with additional type Ea in six (11.8%). Liver function test were normal in 42 patients (82.4%). Segmental atrophy was observed in 12 (23.5%). Treatments included left lateral sectionectomy in 24 (47.1%), left hepatectomy in 14 (27.5%) and right hepatectomy in eight (15.7%), with associated hepaticojejunostomy in four (7.8%). Laparoscopic liver resection was performed in eight (15.7%). Postoperative complications were observed in 20 (39.2%) with no mortality. Conclusion: Liver resection in patients with hepatolithiasis is the ideal procedure as it removes stones, stricture, atrophic parenchyma, and minimizes the risk of cholangiocarcinoma.


RESUMO Racional: Litíase intra-hepática primária é definida quando os cálculos são formados dentro do fígado, podendo estar associada à dilatação local e estenosa da via biliar. A ressecção hepática é considerada o procedimento ideal. Objetivo: Avaliar os resultados da ressecção hepática no tratamento da litíase intra-hepática não oriental. Métodos: Cinquenta e um pacientes com hepatolitíase benigna não oriental sintomática foram submetidos à ressecção hepática em seis instituições no Brazil. Os dados demográficos, sintomas clínicos, classificação, diagnóstico, tratamento e evolução pós-operatória foram analisados. Resultados: Dos 51 pacientes havia 28 homens (54,9%), e a idade média era de 49,3 anos. História de colangite foi observada em 15 pacientes (29,4%). Os tipos de litíase observados foram tipo I em 39 (76,5%) e tipo IIb em 12 (23,5%), com o tipo adicional Ea em seis pacientes (11,8%). Os testes de função hepática estavam normais em 42 (82,4%) e atrofia segmentar foi observada em 12 (23,5%). O tratamento incluiu setorectomia lateral esquerda em 24 (47,1%), hepatectomia esquerda em 14 (27,5%) e hepatectomia direita em oito pacientes (15,7%). A hepaticojejunostomia esteve associada ao procedimento inicial em quatro (7,8%). Hepatectomia por videolaparoscopia foi realizada em oito (15,7%). Complicações pós-operatórias foram observadas em 20 pacientes (39,2%) e não houve mortalidade. Conclusão: Ressecção hepática na hepatolitíase é o procedimento ideal, pois remove os cálculos, a estenose, o parênquima atrofiado e minimiza os riscos para colangiocarcinoma.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Lithiasis/surgery , Hepatectomy/methods , Liver Diseases/surgery , Treatment Outcome
6.
Rev. méd. Chile ; 146(6): 753-761, jun. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961456

ABSTRACT

Background: Ruptured subscapular liver hematoma in context of HELLP syndrome is a rare complication with high mortality. Clinical presentation is nonspecific: epigastric pain, right upper quadrant pain and shoulder pain, should however provide high index of suspicion. Termination of pregnancy is the only definitive treatment with a beneficial effect on the mother and the fetus. According to the hemodynamic status of the patient, treatment can be conservative through hepatic artery embolization, or surgical management, via contained packing of the bleeding area. Aim: To report seven cases of ruptured subscapular liver hematomas treated in a period of 13 years. Material and Methods: Review of medical records of patients discharged with the diagnosis from 2002 to 2015. Results: We identified seven women aged 30 to 44 years, for a total of 86,858 live births. At presentation, mean gestational age was 36 weeks. Five patients reported epigastric pain and three shoulder pain. All patients met the criteria for HELPP syndrome. All patients were operated on, and packing of the bleeding zone was carried out in six. One patient died. Two newborns died. Conclusions: The features of these patients may help in the management of this uncommon but severe condition.


Subject(s)
Humans , Female , Pregnancy , Adult , HELLP Syndrome/diagnosis , Hematoma/surgery , Hematoma/etiology , Liver Diseases/surgery , Liver Diseases/etiology , Pre-Eclampsia , Rupture, Spontaneous/surgery , Rupture, Spontaneous/etiology , Time Factors , Severity of Illness Index , Pregnancy Outcome , Medical Records , Retrospective Studies , Gestational Age , Treatment Outcome , Length of Stay
7.
Rev. bras. anestesiol ; 68(2): 190-193, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-897833

ABSTRACT

Abstract Background: Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes. Case report: We report the case of a 40 years old female, ASA III, scheduled for hepatothorax repair that evolved from right diaphragmatic hernia after a car accident when she was 8 years old. Clinically, she had severe restrictive respiratory syndrome caused by the hepatothorax. The anesthetic evaluation was normal, except for the chest X-ray showing elevation of the dome of the right hemidiaphragm without tracheal deviation. Diagnosis was confirmed by CT scan. After liver replacement in the abdominal cavity, a transient increase in central venous pressure, stroke volume index and flow time corrected (35%), and a decrease in systemic vascular resistance were observed. After complete hemodynamic and hepatosplenic stabilization, as well as ventilation, the patient was transferred intubated, under controlled ventilation and monitored, to the liver transplant unit. Conclusions: Hepatothorax is a rare condition and its repair may represent an anesthetic challenge. After liver replacement in the abdominal cavity during corrective surgery under general anesthesia complications may occur, particularly associated with pulmonary re-expansion. Effective teamwork and careful planning of surgery, between the surgical and anesthetic teams, are the key to success.


Resumo Justificativa: A ruptura diafragmática é uma condição incomum e ocorre em 90% no lado esquerdo. No entanto, a incidência de ruptura à direita tem vindo a aumentar junto com o aumento dos acidentes automobilísticos. A herniação do fígado pode tornar-se progressiva, causar atelectasia grave do pulmão direito, resultar num débil estado respiratório e alterações hemodinâmicas. Relato de caso: Mulher de 40 anos, estado físico ASA 3, marcada para reparação de hepatotórax que evoluiu de hérnia diafragmática direita, adquirida aos 8 anos, após um acidente automobilístico. Clinicamente apresentava síndrome respiratória restritiva grave, causada pelo hepatotórax. A avaliação anestésica era normal, com exceção da radiografia do tórax, que evidenciava elevação da hemicúpula diafragmática direita, sem desvio traqueal. Diagnóstico foi confirmado por tomografia computadorizada. Depois da recolocação do fígado na cavidade abdominal foram observados um aumento transitório da pressão venosa central, do Stroke Volume Index e Flow Time Corrected (35%) e uma diminuição da resistência vascular sistêmica. Uma vez alcançada a estabilização hemodinâmica geral e hepatoesplênica, bem como da ventilação, a paciente foi transferida entubada, sob ventilação controlada e monitorada para a Unidade de Transplantação Hepática. Conclusões: O hepatotórax é uma condição rara e a sua correção pode representar um desafio anestésico. Após a recolocação abdominal do fígado, durante uma cirurgia corretiva, sob anestesia geral, podem ocorrer complicações, principalmente as associadas à reexpansão pulmonar. Um trabalho em equipe eficaz e o planejamento cuidadoso da cirurgia, entre as equipes cirúrgica e anestésica, são a chave para o sucesso.


Subject(s)
Humans , Female , Adult , Herniorrhaphy , Hernia, Diaphragmatic, Traumatic/surgery , Anesthesia , Liver Diseases/surgery , Chronic Disease , Hernia/etiology , Hernia, Diaphragmatic, Traumatic/complications , Liver Diseases/etiology
9.
Clinics ; 72(6): 351-357, June 2017. tab
Article in English | LILACS | ID: biblio-840092

ABSTRACT

OBJECTIVE: The aim of this research was to compare language development (expressive and receptive skills) in children awaiting liver transplantation with that of children who have already undergone the surgical procedure. METHODS: An observational, descriptive, cross-sectional study was conducted with 76 children divided into groups, as follows: 31 children who were candidates for liver transplantation (Group 1; G1), 45 children who had already undergone liver transplantation (Group 2; G2), and a control group (CG) of 60 healthy, normally developing children. Health status information was gathered, and the Test of Early Language Development (TELD)-3 was used to assess language skills. Family household monthly income data were also gathered using a specific questionnaire. RESULTS: G1 had poorer language performance compared with G2 and the CG. G2 had lower language performance when compared with the CG. However, when considering the TELD-3 standard scores, G2 had scores within normal limits. The regression analysis indicated age as a risk factor for language deficits in Group 1 and family income as a risk factor for language deficits in G2. CONCLUSIONS: The results suggested that children with chronic liver disease have delays in language development. Transplanted children have linguistic performance within normal limits, but their scores tended to be lower than the CG.


Subject(s)
Humans , Male , Female , Child , Language Disorders/complications , Liver Diseases/complications , Brazil , Case-Control Studies , Cross-Sectional Studies , Language Disorders/diagnosis , Language Tests , Liver Diseases/surgery , Liver Transplantation , Risk Factors , Severity of Illness Index , Socioeconomic Factors
10.
Rev. cuba. cir ; 55(2): 0-0, abr.-jun. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-791491

ABSTRACT

Introducción: el tratamiento de las afecciones del sistema hepatobiliopancreático dista mucho de ser el óptimo a pesar de los avances conseguidos con la incorporación de nuevos procedimientos diagnósticos y terapéuticos; sin embargo, las derivaciones bilioentéricas son consideradas una alternativa valiosa en el tratamiento. Objetivo: caracterizar el tratamiento de las afecciones del sistema hepatobiliopancreático con el uso de la hepaticoyeyunostomía, en el servicio de cirugía general del hospital Dr. Salvador Allende, desde enero de 2000 hasta diciembre de 2013. Métodos: estudio de corte transversal, retrospectivo-prospectivo y descriptivo. La muestra estuvo constituida por 77 pacientes. Resultados: las enfermedades del sistema hepatobiliopancreático malignas representaron el principal diagnóstico entre nuestros pacientes, con 31 por ciento de complicaciones posoperatoria y cuatro (5,19 por ciento) muertes asociadas al proceder. Conclusiones: la hepaticoyeyunostomía es una opción terapéutica segura en aquellos pacientes con enfermedad hepatobiliopancreática cuando no exista la adecuada factibilidad de métodos endoscópicos derivativos, ante el fallo de estos o el fracaso de la descompresión percutánea(AU)


Introduction: the treatment of disorders of the hepatobiliopancreatic system is far from being despite the progress made with the incorporation of new diagnostic and therapeutic procedures; however, biliary-enteric by-passes are considered a valuable alternative in the treatment. Objective: to characterize the treatment of hepatobiliopancreatic system affections using hepaticojejunostomy, in the Department of General Surgery Dr. of Salvador Allende Hospital, from January 2000 to December 2013. Methods: a cross-sectional, retrospective-prospective and descriptive study was carried out. The sample consisted of 77 patients. Results: the malignant disease of the hepatobiliopancreatic system were the main diagnosis among our patients, with 31 percent of postoperative complications and four (5.19 percent) deaths associated with the procedure. Conclusions: hepaticojejunostomy is a safe therapeutic option for patients with hepatobiliopancreatic disease, when there is no adequate feasibility of endoscopic derivative methods, in face of the failure of these or that of percutaneous decompression(AU)


Subject(s)
Humans , Female , Anastomosis, Roux-en-Y/methods , Liver Diseases/surgery , Cross-Sectional Studies , Epidemiology, Descriptive , Retrospective Studies
12.
Rev. Nac. (Itauguá) ; 8(1): 78-82, jun 2016.
Article in Spanish | LILACS, BDNPAR | ID: biblio-884718

ABSTRACT

El hematoma subcapsular es una complicación grave elevado riesgo de mortalidad materna y neonatal, se observa como complicación de patologías hipertensivas más frecuentemente, además de otras patologías graves como hígado graso agudo del embarazo, traumatismos, patologías infecciosas. Se instala durante el embarazo o post parto, con manifestaciones clínicas inespecíficas, con grave y rápido deterioro materno que de no diagnosticar y tratar en tiempo y forma. Produce muerte materna en un 75% y fetal 60%. Se presenta un caso de hematoma hepático como complicación de una eclampsia y síndrome de Hellp, que evolucionó en forma favorable. Tratada con electrocoagulación el cual usamos para tratamiento de la hemorragia.


The subcapsular hematoma is a serious complication, with high risk of maternal and neonatal mortality, it is seen as a complication of hypertensive diseases more frequently, busides another serious diseases such as acute fatty liver of pregnancy, trauma, infectious diseases. It is onset occurs during pregnancy or postpartum, with nonspecific clinical manifestations, with severe and rapid material deterioration which of not diagnosed and treated from the beginning could produce maternal death in 75% and fetal 60%. We present a case of liver hematoma as a complication of eclampsia and Hellp syndrome, whose evolution was favorable, treated with electrocoagulation which we use for the treatment of hemorrhage.


Subject(s)
Humans , Female , Pregnancy , Adult , HELLP Syndrome , Eclampsia , Hematoma/surgery , Liver Diseases/surgery , Hematoma/etiology , Liver/pathology , Liver Diseases/etiology
13.
Int. braz. j. urol ; 41(1): 116-123, jan-feb/2015. tab, graf
Article in English | LILACS | ID: lil-742880

ABSTRACT

Purpose To determine the safety of continued administration of antithrombotic agents during transperineal (TP) prostate biopsy. Patients and Methods A total of 811 men who underwent transrectal ultrasound (TRUS)-guided TP biopsy from January 2008 to June 2012 at our two institutions were retrospectively analyzed. Among these 811 men, 672 received no antithrombotic agents (group I), 103 received and continued administration of antithrombotic agents (group II), and 36 interrupted administration of antithrombotic agents (group III). Overall complications were graded and hemorrhagic complications were compared (group I with group II) using propensity score matching (PSM) analysis. Results An overall complication rate of 4.6% was recorded. Hemorrhagic complications occurred in 1.8% and they were virtually identical in all the three groups, and no severe hemorrhagic complications occurred. One patient in group III required intensive care unit admission for cerebral infarction. PSM analysis revealed no statistical difference between groups I and II with regard to the incidence of gross hematuria, perineal hematoma, and rectal bleeding. Multiple regression analysis revealed that hemorrhagic complications were associated with lower body mass index (<21 kg/m2, P=0.0058), but not with administration of antithrombotic agents. Conclusions Continued administration of antithrombotic agents does not increase the risk of hemorrhagic complications; these agents are well tolerated during TP biopsy. .


Subject(s)
Adolescent , Adult , Animals , Child , Child, Preschool , Female , Humans , Infant , Male , Mice , Young Adult , Hepatocytes/transplantation , Liver Diseases/pathology , Liver Transplantation/methods , Liver/pathology , Hepatocytes/cytology , Hepatocytes/metabolism , Liver Diseases/metabolism , Liver Diseases/surgery , Liver/metabolism , Liver/surgery
14.
ABCD arq. bras. cir. dig ; 27(3): 191-195, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-720386

ABSTRACT

BACKGROUND: Despite the increasing number of laparoscopic hepatectomy, there is little published experience. AIM: To evaluate the results of a series of hepatectomy completely done with laparoscopic approach. METHODS: This is a retrospective study of 61 laparoscopic liver resections. Were studied conversion to open technique; mean age; gender, mortality; complications; type of hepatectomy; surgical techniques applied; and simultaneous operations. RESULTS: The conversion to open technique was necessary in one case (1.6%). The mean age was 54.7 years (17-84), 34 were men. Three patients (4.9%) had complications. One died postoperatively (mortality 1.6%) and no deaths occurred intraoperatively. The most frequent type was right hepatectomy (37.7%), followed by bisegmentectomy (segments II-III and VI-VII). Were not used hemi-Pringle maneuvers or assisted technic. Six patients (8.1%) underwent simultaneous procedures (hepatectomy and colectomy). CONCLUSION: Laparoscopic hepatectomy is feasible procedure and can be considered the gold standard for various conditions requiring liver resections for both benign to malignant diseases. .


RACIONAL: Apesar do número crescente de hepatectomias laparoscópicas, ainda há pouca experiência publicada. OBJETIVO: Avaliar os resultados de uma série de hepatectomia totalmente feita com abordagem laparoscópica. MÉTODOS: Estudo retrospectivo incluindo 61 ressecções laparoscópicas hepáticas. Foram estudadas a conversão para técnica aberta; média de idade; gênero, mortalidade; complicações; tipo da hepatectomia; técnicas cirúrgicas aplicadas; e operações simultâneas. RESULTADOS: A conversão para técnica aberta foi necessária em um caso (1,6%). A média de idade foi de 54,7 anos (17-84), 34 eram homens. Três pacientes (4,9%) tiveram complicações. Um faleceu no pós-operatório (mortalidade de 1,6%) e não ocorreram óbitos no intra-operatório. O tipo mais frequente foi hepatectomia direita (37,7%), seguido por bissegmentectomia (segmentos II-III e VI-VII). Não foram utilizados manobras hemi-Pringle ou técnica assistida, e foi evitado o acesso ao pedículo glissoniano (intra-hepática). Seis pacientes (8,1%) foram submetidos a procedimentos simultâneos (hepatectomia e colectomia). CONCLUSÃO: A hepatectomia laparoscópica é procedimento viável e considerado padrão-ouro para várias condições que necessitam resseções hepáticas tanto para doenças benignas com para malignas. .


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Hepatectomy/methods , Laparoscopy , Liver Diseases/surgery , Brazil , Retrospective Studies
16.
ABCD arq. bras. cir. dig ; 26(4): 302-308, nov.-dez. 2013. ilus, tab
Article in Portuguese | LILACS | ID: lil-701253

ABSTRACT

RACIONAL: Na esquistossomose mansônica na forma hepatoesplênica ocorre fibrose hepática difusa que associada à congestão venosa do sistema porta resulta em hepatoesplenomegalia. Pode produzir hemorragia digestiva alta por rotura das varizes de esôfago e do estômago ou lesões pépticas da mucosa gastroduodenal. OBJETIVO: Estudar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre a hemodinâmica portohepática. MÉTODO: Vinte e três portadores de esquistossomose mansônica na forma hepatoesplênica foram estudados prospectivamente, antes e cerca de duas semanas após a operação, através de estudos angiográficos dos diâmetros da artéria hepática comum e própria, artéria esplênica, artéria mesentérica superior, veia porta, veia mesentérica superior e veia gástrica esquerda. Foram aferidas as pressões da veia cava inferior, venosa central, da veia hepática livre, da veia hepática ocluída e sinusoidal. RESULTADOS: A ligadura da veia gástrica esquerda determinou acréscimo significante nas seguintes variáveis: diâmetros da artéria hepática comum e própria; diâmetro da veia mesentérica superior; o acréscimo não foi significante nas seguintes medidas: pressão venosa central e diâmetro da artéria mesentérica superior. Ela promoveu decréscimo não significante nas variáveis: pressão da veia cava inferior; pressão da veia hepática livre; pressão da veia hepática ocluída; pressão sinusoidal; diâmetro da veia porta. CONCLUSÃO: A ligadura da veia gástrica esquerda, na maioria dos casos, não determina alterações hemodinâmicas significantes do sistema porta capazes de quebrar o equilíbrio hemodinâmico funcional, que caracteriza a esquistossomose mansônica na forma hepatoesplênica.


BACKGROUND: In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions. AIM: To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics. METHOD: Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured. RESULTS: The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein. CONCLUSION: Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Liver Diseases/physiopathology , Liver Diseases/surgery , Splenectomy , Schistosomiasis mansoni/physiopathology , Schistosomiasis mansoni/surgery , Splenic Diseases/parasitology , Splenic Diseases/physiopathology , Angiography , Blood Pressure , Hemodynamics , Ligation , Liver Diseases/parasitology , Postoperative Period , Preoperative Period , Splenic Diseases/surgery , Veins/surgery
17.
Int. j. morphol ; 31(3): 1116-1119, set. 2013. ilus
Article in Spanish | LILACS | ID: lil-695009

ABSTRACT

Los quistes hepáticos no hidatídicos (QHNH) se detectan de forma incidental, pueden ser únicos y múltiples. Desde que se describió el tratamiento laparoscópico de estos, se han reportado diversas series; existiendo por ende evidencia que avala la cirugía laparoscópica de estas lesiones. El objetivo de este estudio, es reportar los resultados del tratamiento laparoscópico de QHNH en términos de morbilidad postoperatoria (MPO). Serie de casos. Se incluyeron pacientes intervenidos quirúrgicamente vía laparoscópica por QHNH en el Hospital Clínico de la Universidad Mayor entre enero de 2008 y diciembre de 2012. El estudio preoperatorio consistió en exámenes generales, determinación de ELISA-IgE e IgG para hidatidosis, ecotomografía abdominal o tomografía computarizada. En el período estudiado, se intervinieron 17 pacientes con QHNH, resecándose en ellos, un total de 39 quistes. El 76,5 por ciento de los casos eran de sexo femenino; y la mediana de edad de la serie fue de 56 años. La mediana del diámetro ecográfico de las lesiones fue de 7,5 cm. Se realizó quistectomía subtotal en todos ellos, sin utilización de drenaje. Se realizó epiploplastia en 4 pacientes. En el 82,4 por ciento de los casos se ejecutó de forma simultánea una colecistectomía por colelitiasis. La mediana del tiempo quirúrgico fue de 51 minutos. No fue necesario convertir a ningún paciente. La serie no registra MPO ni mortalidad. La mediana de estancia hospitalaria fue de 1 día. El estudio histopatológico confirmó "quiste de tipo biliar" en la totalidad de los casos. Con un seguimiento mínimo de 6 meses, no se ha evidenciado MPO tardía ni reaparición de las lesiones resecadas. El tratamiento aplicado a esta serie de casos de QHNH, se asocia a escasa estancia hospitalaria y buena evolución a corto y mediano plazo.


Nonparasitic hepatic cysts (NPHC) can be detected incidentally, and may be single or multiple. Since described laparoscopic treatment of NPHC, several series have been reported, therefore there is enough evidence that support the role of laparoscopic surgery in the treatment of NPHC. The aim of this study is to report the results of laparoscopic treatment of QHNH in terms of postoperative morbidity (POM). Case series. Patients operated laparoscopically by NPHC in the Universidad Mayor Clinical Hospital, Temuco, between January 2008 and December 2012 were included. The preoperative evaluation consisted of general exams, ELISA-IgE and IgG determination for hydatid disease, abdominal ultrasonography or abdominal CT scan. During the study period, 17 patients with NPHC were operated, resecting them a total of 39 cysts. 76.5 percent of patients were female, and the median age of the series was 56 years. The median sonographic diameter of the lesions was 7.5 cm. Subtotal cystectomy was performed in all of them, without using drainage. Epiploplasty was performed in 4 patients. In 82.4 percent of cases simultaneously cholecystectomy for cholelithiasis was performed. The median operative time was 51 minutes. Neither patient was converted. The series does not register MPO or mortality. The median hospital stay was 1 day. Histopathology confirmed the "biliary type cyst" in all cases. With a minimum follow up of 6 months, there is no evidence or late MPO or recurrence of the lesions resected. The treatment applied to this series of NPHC, is associated with short hospital stay and good outcome in the short and medium term.


Subject(s)
Humans , Male , Female , Middle Aged , Liver Diseases/surgery , Laparoscopy/methods , Cysts/surgery , Follow-Up Studies , Length of Stay , Treatment Outcome
18.
ABCD arq. bras. cir. dig ; 25(4): 273-278, out.-dez. 2012. ilus, tab
Article in Portuguese | LILACS | ID: lil-665747

ABSTRACT

INTRODUÇÃO: A trombose de veia porta foi considerada contraindicação ao transplante de fígado no passado em razão da elevada morbi-mortalidade. Diversos avanços permitiram melhora dos resultados. OBJETIVO: Revisão dos avanços e das estratégias cirúrgicas utilizadas para realização do transplante de fígado na vigência de trombose de veia porta. MÉTODO: Revisão da literatura nas bases de dados Medline, Scielo, Lilacs cruzando os descritores: portal vein thrombosis, liver transplantation, vascular complications, jump graft, graft failure, multivisceral transplant. Foram estudados a epidemiologia, fatores de risco, classificação, diagnóstico, estratégias cirúrgicas e resultados. CONCLUSÃO: A trombose de veia porta deixou de ser contraindicação para o transplante hepático. O cirurgião dispõe atualmente de uma série de estratégias para realização do transplante, variando conforme o grau da trombose. Apesar de implicar em maior morbidade e taxas de re-trombose, os resultados do transplante na presença de trombose portal são semelhantes aos observados nas séries habituais.


BACKGROUND: Portal vein thrombosis was considered a contraindication for liver transplantation in the past because of the high morbidity and mortality rates. Many advances made the results better. AIM: Review the advances and surgical strategies for liver transplantation in presence of portal vein thrombosis. METHOD: Survey of publications in Medline, Scielo and Lilacs databases. Headings crossed: portal vein thrombosis, liver transplantation, vascular complications, jump graft, graft failure, multivisceral transplant. Data analyzed were epidemiology, risk factors, classification, diagnosis, surgical strategies and outcomes. CONCLUSION: Portal vein thrombosis is not a contraindication for liver transplantation anymore. There are many strategies to perform the liver transplantation in this condition, depending on portal vein thrombosis grade. Regardless higher morbidity and re-trhombosis rates, the outcomes of liver transplantation in portal vein thrombosis are similar to series without portal vein thrombosis.


Subject(s)
Humans , Liver Diseases/complications , Liver Diseases/surgery , Liver Transplantation/methods , Portal Vein , Venous Thrombosis/complications
19.
Arq. bras. cardiol ; 96(1): 26-30, jan. 2011. tab
Article in Portuguese | LILACS | ID: lil-573602

ABSTRACT

FUNDAMENTO: A insuficiência hepática avançada (IHA) geralmente cursa com hipocolesterolemia. Apesar disso, uma parcela dos pacientes com IHA desenvolve coronariopatia obstrutiva de grau importante com consequente aumento de risco ou até contraindicação para transplante hepático. OBJETIVO: Analisar a contribuição dos fatores de risco clássicos para doença arterial coronariana (DAC) em pacientes portadores de IHA com e sem coronariopatia obstrutiva. MÉTODOS: Avaliação dos fatores de risco para DAC em 119 pacientes, em um serviço de referência para transplante hepático, com as seguintes características: mais de 40 anos de idade, portadores de IHA e submetidos a cinecoronariografia. RESULTADOS: Coronariopatia obstrutiva foi detectada em 21 (17,6 por cento) dos casos. Esses pacientes apresentavam realmente níveis baixos de colesterol, sendo de 129,0 ± 53,5 mg/dl com mediana de 117,0 mg/dl nos hepatopatas com coronárias normais e 135,4 ± 51,7 mg/dl com mediana de 122,0 mg/dl nos hepatopatas com coronariopatia obstrutiva (P=0,8215). Na regressão logística multivariada, a idade, o sexo, o índice de massa corporal, bem como as presenças de diabete, de tabagismo e de etilismo não tiveram significância estatística isolada na diferenciação entre os grupos. Também não houve associação com a etiologia da IHA. Por sua vez, a hipertensão arterial mostrou-se relevante na associação com DAC (P=0,0474). CONCLUSÃO: Apenas a hipertensão arterial foi fator de risco com significância estatística para o desenvolvimento de DAC em pacientes com IHA aguardando transplante hepático. Por ser um fator de risco modificável, esse achado orienta a prática de atitudes terapêuticas na tentativa de evitar ou retardar o desenvolvimento da DAC nesses pacientes.


BACKGROUND: Advanced liver failure (ALF) usually presents hypocholesterolemia. Nevertheless, some patients with ALF develops major coronary obstructive diseases with consequent increased risk or contraindication to liver transplantation. OBJECTIVE: To analyze the contribution of classical risk factors for coronary artery disease (CAD) in patients with ALF with and without obstructive coronary disease. METHODS: Evaluation of risk factors for CAD in 119 patients in a referral center for liver transplantation, with the following characteristics: patients older than 40 years of age with ALV who underwent coronary angiography. RESULTS: Obstructive coronary disease was detected in 21 (17.6 percent) of the cases. These patients had really low cholesterol levels, of which 129.0 ± 53.5 mg/dl averaging 117.0 mg/dl in liver disease patients with normal coronary arteries and 135.4 ± 51.7 mg/dl averaging 122.0 mg/dl in liver disease patients with obstructive coronary artery disease (P = 0.8215). In multivariate logistic regression, age, sex, body mass index and the presence of diabetes, smoking and alcohol consumption were not statistically significant in distinguishing groups. Nor was there an association with the etiology of the ALF. In turn, hypertension was proven to be relevant in association with CAD (P = 0.0474). CONCLUSION: Only hypertension was a risk factor with statistical significance for the development of CAD in patients with ALF awaiting liver transplantation. Because it is a modifiable risk factor, this finding guides the practice of therapeutic attitudes in an attempt to prevent or delay the development of CAD in these patients.


FUNDAMENTO: La insuficiencia hepática avanzada (IHA) generalmente cursa con hipocolesterolemia. A pesar de eso, una parcela de los pacientes con IHA desarrolla coronariopatía obstructiva de grado importante con consecuente aumento de riesgo o incluso contraindicación para trasplante hepático. OBJETIVOS: Analizar la contribución de los factores de riesgo clásicos para la enfermedad arterial coronaria (EAC) en pacientes portadores de IHA con y sin coronariopatía obstructiva. MÉTODOS: Evaluación de los factores de riesgo para EAC en 119 pacientes, en un servicio de referencia para trasplante hepático, con las siguientes características: más de 40 años de edad, portadores de IHA y sometidos a cinecoronariografía. RESULTADOS: Coronariopatía obstructiva fue detectada en 21 (17,6 por ciento) de los casos. Estos pacientes presentaban realmente niveles bajos de colesterol, siendo de 129,0±53,5mg/dL con mediana de 117,0mg/dL en los hepatópatas con coronarias normales y 135,4±51,7mg/dL con mediana de 122,0mg/dL en los hepatópatas con coronariopatía obstructiva (P=0,8215). En la regresión logística multivariada, la edad, el sexo, el índice de masa corporal, así como las presencias de diabetes, de tabaquismo y de etilismo no tuvieron significancia estadística aislada en la diferenciación entre los grupos. También no hubo asociación con la etiología de la IHA. A su vez, la hipertensión arterial se mostró relevante en la asociación con EAC (P=0,0474). CONCLUSIÓN: Sólo la hipertensión arterial fue factor de riesgo con significancia estadística para el desarrollo de EAC en pacientes con IHA aguardando trasplante hepático. Por ser un factor de riesgo cambiable, este hallazgo orienta hacia una práctica de actitudes terapéuticas en la tentativa de evitarse o retardar el desarrollo de la EAC en estos pacientes.


Subject(s)
Adult , Female , Humans , Male , Coronary Artery Disease/complications , Liver Transplantation , Liver Diseases/complications , Chronic Disease , Hypertension/complications , Liver Diseases/surgery , Risk Factors
20.
Rev. chil. cir ; 62(2): 138-143, abr. 2010. tab
Article in Spanish | LILACS | ID: lil-563784

ABSTRACT

Background: Chile has a high incidence of cholelithiasis and associated complications, that usually require surgical treatment. Aim: Lo carry out an enquiry about biliary diseases and their surgical treatment in public and prívate surgical services in Chile. Material and Methods: An enquiry about liver and biliary diseases and their treatment was designed and sent by electronic mail to 35 surgical services. Results: Lhe enquiry was answeredby 17 services. A total of 9.505 cholecystectomies were reported. Between21 and 98 percent of the procedures were laparoscopic. Iatrogenic lesions of the biliary tree were reported in 0.3 percent of the procedures. Choledocolithiasis was found associated to cholelithiasis in 0 to 21 percent of procedures. However, the use of intraoperative cholangiography was incidental. Lhe incidence of gallbladder cancer in cholecystectomies for cholelithiasis fluctuated between 0.2 and 8.9 percent. Liver metastases derived from colorectal cancer were the most common liver tumor operated. Hydatidosis was more common in southern Chile. Pancreatic excision was almost exclusively performed in Metropolitan Santiago. Conclusions: This information will allow the establishment of information and collaboration channels among the surgical services throughout Chile.


Se trata de una encuesta realizada con el objeto de conocer la frecuencia e incidencia de las principales patologías y técnicas quirúrgicas de la esfera hepato-bilio-pancreática atendida en centros de salud públicos y privados del país durante el año 2007. La encuesta fue respondida por 17 instituciones nacionales. Entre los resultados resaltan el total de colecistectomías reportadas de 9.505, de las cuales entre un 21 y 98 por ciento son realizadas por vía laparoscópica. Lesiones iatrogénicas de vía biliar ocurrieron dentro de un rango de 0 a 1,5 por ciento, con una mediana de 0,3 por ciento. La frecuencia de coledocolitiasis asociada a la colelitiasis ocurrió entre un 0 a 21 por ciento, aunque el empleo de colangiografía intraoperatoria es en general de ocurrencia incidental. La incidencia de cáncer vesicular en colecistectomías por colelitiasis es claramente distinta según se trate de instituciones de centro-norte y sur del país, con incidencias que varían entre 0,2 y 8,9 por ciento. Las metástasis hepáticas operadas son principalmente de origen colorrectal, y son los tumores hepáticos más frecuentemente tratados. La hidatidosis hepática manifiesta en esta encuesta su conocida distribución geográfica, siendo más frecuentemente tratada en los centros del sur del país. La cirugía pancreática resectiva tiende a estar concentrada en las instituciones de la región metropolitana.


Subject(s)
Humans , Cholecystectomy/statistics & numerical data , Pancreatic Diseases/surgery , Pancreatic Diseases/epidemiology , Biliary Tract Diseases/surgery , Biliary Tract Diseases/epidemiology , Liver Diseases/surgery , Liver Diseases/epidemiology , Chile/epidemiology , Cholecystectomy, Laparoscopic/statistics & numerical data , Cholelithiasis/surgery , Cholelithiasis/epidemiology , Data Collection , Echinococcosis, Hepatic/surgery , Echinococcosis, Hepatic/epidemiology , Hospitals, Private/statistics & numerical data , Hospitals, Public/statistics & numerical data , Incidence , Neoplasm Metastasis , Liver Neoplasms/surgery , Liver Neoplasms/epidemiology , Gallbladder Neoplasms/surgery , Gallbladder Neoplasms/epidemiology
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