Colecistitis Aguda en el paciente crítico: ¿colecistostomía percutánea o colecistectomía quirúrgica? Revisión simple / Acute cholecystitis in the critical patient: percutaneous cholecistostint or surgical cholecistectomy? Simple review

Introducción: La colecistitis aguda es una patología quirúrgica común. Su resolución ideal es a través de la colecistectomía. En ocasiones, no es posible el abordaje quirúrgico, tomando protagonismo la colecistostomía percutánea. El objetivo de este trabajo fue analizar los resultados de la colecistostomía percutánea y de la colecistectomía quirúrgica en pacientes con colecistitis aguda. Material y Métodos: Se diseñó una revisión de trabajos clínicos que realizaron colecistostomías percutáneas y/o colecistectomías quirúrgicas en pacientes críticos con colecistitis aguda litiásica y/o alitiásica. Resultados: La búsqueda bibliográfica arrojó 12 artículos, de los cuáles se excluyeron 8 y se analizaron 4. De los artículos revisados, se reunieron 11374 pacientes con colecistitis (litiásica: 84,6% vs. alitiásica: 15,4%) analizando sus datos epidemiológicos. En el 21,4% de los casos se realizó colecistostomía percutánea y en el 78,6% colecistectomía quirúrgica. La morbilidad y mortalidad de los procedimientos percutáneos fue 11% y 9,8%, mientras que la de los procedimientos quirúrgicos fue 17,2% y 5,4%, respectivamente. El promedio de días de hospitalización fue 15.3 y 15.5, respectivamente. Conclusión: La colecistostomía percutánea presentó menor morbilidad, aunque reportó una mayor mortalidad. No hubo diferencias con respecto a la estadía hospitalaria. Los procedimientos percutáneos fueron menos costosos.

Introduction: Acute cholecystitis is a common surgical pathology. Its ideal resolution is through cholecystectomy. On occasions, a surgical approach is not possible, with percutaneous cholecystostomy taking center stage. The objective of this work was to analyze the results of percutaneous cholecystostomy and surgical cholecystectomy in patients with acute cholecystitis. Methods: A review of clinical studies that performed percutaneous cholecystostomies and / or surgical cholecystectomies in critically ill patients with acute lithiasic and / or alithiasic cholecystitis was designed. Results: The bibliographic search yielded 12 articles, of which 8 were excluded and 4 were analyzed. Of the articles reviewed, 11,374 patients with cholecystitis (lithiasic: 84.6% vs. alithiasic: 15.4%) were collected, analyzing their data epidemiological. Percutaneous cholecystostomy was performed in 21.4% of the cases and surgical cholecystectomy in 78.6%. The morbidity and mortality of percutaneous procedures was 11% and 9.8%, while that of surgical procedures was 17.2% and 5.4%, respectively. The average days of hospitalization were 15.3 and 15.5, respectively. Conclusion: Percutaneous cholecystostomy presented lower morbidity, although it reported higher mortality. There were no differences regarding hospital stay. Percutaneous procedures were less expensive.

Percutaneous radiofrequency assisted liver partition with portal vein embolization for staged hepatectomy (pralpps) / Divisão hepática assistida com embolização da veia porta para hepatectomia regrada usando radiofrequência percutânea

ABSTRACT Background: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. Aim: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. Methods: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein. By contrasted CT, the difference between the liver parenchyma corresponding to the embolized zone and the normal one was identified. Immediately, using the fusion of images between ultrasound and CT as a guide, radiofrequency needles were placed percutaneouslyand then ablated until the liver partition was complete. Finally, hepatectomy was completed with a laparoscopic approach. Results: All animals have survived the procedures, with no reported complications. The successful portal embolization process was confirmed both by portography and CT. In the macroscopic analysis of the pieces, the depth of the ablation was analyzed. The hepatic hilum was respected. On the other hand, the correct position of the embolization material on the left portal vein could be also observed. Conclusion: "Percutaneous radiofrequency assisted liver partition with portal vein embolization" (PRALLPS) is a feasible procedure.

RESUMO Racional: Quando grande ressecção hepática é necessária, às vezes, o fígado remanescente não é suficiente para manter a função hepática e os pacientes são mais propensos a desenvolver insuficiência hepática após a operação. Objetivo: Testar a hipótese de que a realização de uma divisão do fígado com radiofreqüência percutânea mais a embolização percutânea da veia porta (PROPS) para a hepatectomia regrada em porcos é viável. Métodos: Quatro porcos (Sus scrofa domesticus) ambos os sexos com pesos entre 25 a 35 kg foram submetidos à embolização percutânea da veia porta com espirais da veia porta esquerda. Por TC contrastada, a diferença entre o parênquima hepático correspondente à zona embolizada e a normal foi identificada. Imediatamente, usando a fusão de imagens entre ultrassom e CT guiada, as agulhas de radiofrequência foram colocadas percutaneamente e depois foram cortando até a partição do fígado estar completa. Finalmente, a hepatectomia foi completada com abordagem laparoscópica. Resultados: Todos os animais sobreviveram aos procedimentos, sem complicações. O sucesso do processo de embolização do portal foi confirmado por portografia e CT. Na análise macroscópica das peças, analisou-se a profundidade da ablação. O hilo hepático foi respeitado. Por outro lado, a posição correta do material de embolização na veia porta esquerda também pôde ser observada. Conclusão: "Partição do fígado assistida por radiofrequência percutânea com embolização da veia porta" (PRALLPS) é um procedimento viável.