ABSTRACT
The term ¨Lemmel Syndrome¨ is used to describe obstructive jaundice that is secondary to periampullary duodenal diverticula (PDD) in the absence of choledocholithiasis or neoplasia. PDD is found in 22% of the population. According to our knowledge, only two cases of Lemmel syndrome have been reported in Mexico. We report two cases of Lemmel syndrome in a 94-year-old and a 71-year-old woman who presented with clinical jaundice. One of the cases was treated with endoscopic retrograde cholangiopancreatography (ERCP) sphincterotomy, balloon sweep, and the placement of a plastic biliary prosthesis, and the other with laparoscopic biliodigestive bypass and a manual lateral end choledocho-duodenal anastomosis. Our objective is to expand the information on this rare pathology to take it into account as a diagnostic possibility of jaundice and to define appropriate management, which can be endoscopic or surgical.
ABSTRACT
Introducción. La frecuencia de complicaciones postquirúrgicas de la colecistectomía realizada en la noche es un tema de controversia, siendo que se ha reportado una frecuencia mayor durante el horario nocturno. El objetivo de este estudio fue analizar la presentación de colecistectomía difícil dependiendo de la hora en que se realizó la cirugía, además de otras complicaciones, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Métodos. Se realizó un estudio retrospectivo, observacional, analítico y transversal, comparando la presentación de colecistectomía difícil y su frecuencia en horario diurno (8:00 am a 7:59 pm) y nocturno (8:00 pm a 7:59 am), además de seroma, absceso, hematoma, fuga biliar, biloma, estancia intrahospitalaria postquirúrgica, reingreso a 30 días y reintervención. Resultados. Se incluyeron en el estudio 228 pacientes, 117 operados durante el día (52 %) y 111 durante la noche (48 %). La colecistectomía difícil se presentó 26 % vs 34 % de los casos intervenidos en el día y la noche, respectivamente. La complicación más frecuente fue seroma (14 %). La estancia hospitalaria media fue de 2,7 días en cirugías diurnas y de 2,5 en cirugías nocturnas; hubo 3 % de reintervenciones y 6 %, respectivamente. También hubo 2 % de reingresos a los 30 días entre los pacientes operados en el día y 3 % entre los operados en la noche. Conclusiones. La frecuencia de colecistectomía difícil y las complicaciones, la estancia intrahospitalaria postquirúrgica, el reingreso a 30 días y la necesidad de reintervención, no tuvieron diferencias significativas respecto al horario de la cirugía.
Introduction. The frequency of post-surgical complications of cholecystectomy performed overnight is a matter of controversy, and a higher rate has been reported during the night shift. The objective of this study was to analyze the presentation of difficult cholecystectomy depending on the time the surgery was performed, in addition to other complications, postoperative hospital stay, 30-day readmission, and reintervention. Methods. A retrospective, observational, analytical and cross-sectional study was carried out, comparing the presentation of difficult cholecystectomy and its frequency during daytime (8:00 am to 7:59 pm) and at night (8:00 pm to 7:59 am), in addition of seroma, abscess, bile leak, biloma, hematoma, post-surgical hospital stay, 30-day readmission, and reintervention.Results. A total of 228 patients were included in the study, 117 patients operated during the day (52%), and 111 at night (48%). Difficult cholecystectomy occurred in 26% vs. 34% of the cases operated on during the day and at night, respectively. The most frequent complication was seroma (14%). The mean hospital stay was 2.7 days in day surgeries and 2.5 in night surgeries; there were also 2% readmission at 30 days among patients operated during the day and 3% among those operated on at night. Conclusions. The frequency of difficult cholecystectomy and complications, postoperative hospital stay, 30-day readmission, and the need of reintervention, did not have significant differences with respect to the time of surgery.
