Résumé
Se describe la experiencia en cirugía videolaparoscópica del Servicio de Clínica Quirúrgica, realizada en un período de 3 años (1995-1998). Se presentan los resultados obtenidos en un grupo de 284 pacientes, 204 de sexo femenino y 80 de sexo masculino, con edades comprendidas entre 16 y 82 años (valor promedio 37.66 años). Los diagnósticos ecográficos se comparan con los hallazgos intraoperatorios y de anatomía patológica. Por estudios ecográficos se diagnostican: litiasis vesiculares (250); colecistitis (23); pólipo vesicular (1); cálculos enclavados en el bacinete (10). En el acto intraoperatorio se confirman: litiasis vesiculares (252), colecistitis (23), hidrops vesicular por cálculos enclavados en bacinete (1), pólipo vesicular (1) y adenocarcinoma de vesícula (1). El número de casos operados por patología fue: 255 litiasis vesiculares (89.80%); 27 colecistitis (9.5%), de los que 21 fueron agudos y 6 crónicos; 1 pólipo vesicular (0.35%); 1 adenocarcinoma de vesícula (0.35%). Se convierten a cirugía convencional 14 casos (4.92%) de los 284 casos estudiados: a) 21.42% por hemorragia intraoperatoria (3/14); b) 42.85% por adherencias múltiples (6/14); c) 14.28% por falta de identificación del conducto cístico (2/14); d) 7.14% por cálculo enclavado en cístico (1/14); e) 14.31% por dificultades técnicas (2/14). Se plantean las ventajas de la cirugía videolaparoscópica con respecto a la cirugía convencional. Palabras claves: cirugía videolaparoscópica, colecistectomía, colecistitis, litiasis vesicular.
The experience in laparoscopic surgery of the Clinical Surgery Unit over a three year period (1995-1998) is described in this paper. The results obtained in a group of 284 patients 204 females and 80 males ranging from 16 to 82 years of age - average value 37.66 years- are presented. Ultrasonic diagnoses are compared to intraoperative and pathologic findings. By means of ultrasonic studies the following pathologies were identified: vesicular lithiasis (250); cholecystitis (23); vesicular polyp (1); pelvis-enclaved calculi (10). During surgery the following pathologies were confirmed: vesicular lithiasis (252), cholecystitis (23), vesicular hydrops due to pelvis-enclaved calculi (1), vesicular polyp (1), and vesicular denocarcinoma (1). The number of cases operated due to the pathologies mentioned was the following: 255 vesicular lithiasis (89.80%); 27 cholecystitis (9.5%) among which, 21 were acute cases and 6 were chronic cases -; 1 vesicular polyp (0.35%); and 1 vesicular adenocarcinoma (0.35%). 14 (4.92%)out of 284 cases studied turn into conventional surgery due to the following reasons: a) 21.42% due to intraoperative hemorrhage (3/14); b) 42.85% due to multiple adherences (6/14); c) 14.28% due to lack of cystic duct identification (2/14); d) 7.14% due to a calculus enclaved in the cyst (1/14); e) 14.31% due to technical difficulties (2/14). The advantages of videolaparoscopic surgery over conventional surgery are also outlined in this paper.