Reparación laparoscópica de las lesiones quirúrgicas de la vía biliar: factibilidad y evaluación de resultados / Laparoscopic repair of bile duct injuries: Feasibility and outcomes

Introducción: Las lesiones quirúrgicas de la vía biliar (LQVB) posteriores a la colecistectomía videolaparoscópica tienen una incidencia de 0,6% aproximadamente, siendo por lo general más graves y complejas. La hepaticoyeyunoanastomosis (HYA) en Y de Roux es la mejor opción terapéutica (tasas de éxito entre 75-98%). Algunas series demostraron factible el abordaje laparoscópico en la resolución de esta patología. El objetivo es describir nuestra experiencia en la reparación laparoscópica de las LQVB. Métodos: Estudio retrospectivo y descriptivo. Se incluyeron pacientes sometidos a reparación laparoscópica posterior a LQVB. Se analizaron variables demográficas, clínicas, quirúrgicas y posoperatorias. Se aplicaron análisis estadísticos descriptivos. Resultados: Se evaluaron 92 pacientes con LQVB; 81 se sometieron a reparación quirúrgica, ocho fueron candidatos a HYA laparoscópica (aplicabilidad 9,88%). En 75% (seis) se logró una reparación laparoscópica completa. La mayoría eran mujeres (75%). Edad promedio de 40,8 ± 16,61 años (rango 19-65). Las lesiones Strasberg-Bismuth ≥ E3 afectaron a 25% (dos). En la mitad se realizó una HYA laterolateral según la técnica de Hepp-Couinaud; tres usuarios recibieron una HYA terminolateral y otro una bi-HYA terminolateral en Y de Roux. El tiempo operatorio promedio fue de 260 min (rango 120-360). La morbilidad global fue de 37,5% (tres casos): dos complicaciones menores (bilirragia grado A y hemorragia por drenajes) y una mayor (bilirragia grado C). No se registró mortalidad. El seguimiento máximo fue de 26 meses (rango 6-26). Conclusiones: Nuestro estudio muestra que, en un grupo seleccionado de pacientes, la HYA laparoscópica es factible, con los beneficios de un abordaje miniinvasivo.(AU)

Introduction: Bile duct injuries (BDI) following laparoscopic cholecystectomy occurs in approximately 0.6% of the cases, often being more severe and complex. Roux-en-Y hepaticojejunostomy (RYHJ) is considered the optimal therapeutic option, with success rates ranging from 75% to 98%. Several series have demonstrated the advancements of the laparoscopic approach for resolving this condition. The objective of this study is to describe our experience in the laparoscopic repair of BDI. Methods: A retrospective, descriptive study was conducted, including patients who underwent laparoscopic repair after BDI. Demographic, clinical, surgical, and postoperative variables were analyzed using descriptive statistical analyses. Results: Eight patients with BDI underwent laparoscopic repair (out of 81 surgically repaired patients). Women comprised 75% of the sample. A complete laparoscopic repair was achieved in 75% (6) of cases. The mean age was 40.8 ± 16.61 years (range 19–65). Injuries at or above the confluence (Strasberg–Bismuth ≥ E3) occurred in 25% of cases (2). Primary repair was performed in two cases. Half of the cases underwent a Hepp-Couinaud laterolateral RYHJ, while three patients received a terminolateral RYHJ, and one underwent a bi-terminolateral RYH. The mean operative time was 260 min (range 120–360). Overall morbidity was 37.5% (three cases): two minor complications (bile leak grade A and drainage-related bleeding) and one major complication (bile leak grade C). No mortality was recorded. The maximum follow-up period reached 26 months (range 6–26). Conclusions: Our study demonstrates the feasibility of laparoscopic RYHJ in a selected group of patients, offering the benefits of a minimally invasive approach.(AU)

Symptomatic polycystic liver disease: a rare indication of hepatectomy.

We present the case of forty-four-year-old woman with autosomal dominant Polycystic liver disease (PLD) without kidney disease diagnosed for 18 years ago. She experienced progressive abdominal distension and malnutrition over the previous twelve months. The patient had no other comorbidities. Physical examination revealed an 8 cm hepatomegaly in the right hypochondrium region. Liver function analysis was normal. CT scan showed multiple liver cysts with smooth and regular walls, predominantly in the right lobe which was considered as type III according to Gigot´s classification. Due to the significant hepatomegaly, conventional surgery was performed. Exploration showed multiple cysts of varying sizes on the liver surface, with diffuse involvement of the right hemiliver. Standard right lobe mobilization was technically not possible. Fenestration was performed in dominant superficial cysts, to allow access to the deeper cysts and liver parenchyma. A right hepatectomy was carried up using ultrasound devices and ultrasonic aspirator. And the biggest cysts located in the surface of left hepatic lobe were surgically unroofed. No surgical complications occurred, and the patient was discharged 5 days after the intervention.

Laparoscopic repair of bile duct injuries: Feasibility and outcomes.

INTRODUCTION: Bile duct injuries (BDI) following laparoscopic cholecystectomy occurs in approximately 0.6% of the cases, often being more severe and complex. Roux-en-Y hepaticojejunostomy (RYHJ) is considered the optimal therapeutic option, with success rates ranging from 75% to 98%. Several series have demonstrated the advancements of the laparoscopic approach for resolving this condition. The objective of this study is to describe our experience in the laparoscopic repair of BDI. METHODS: A retrospective, descriptive study was conducted, including patients who underwent laparoscopic repair after BDI. Demographic, clinical, surgical, and postoperative variables were analysed using descriptive statistical analyses. RESULTS: Eight patients with BDI underwent laparoscopic repair (out of 81 surgically repaired patients). Women comprised 75% of the sample. A complete laparoscopic repair was achieved in 75% (6) of cases. The mean age was 40.8 ± 16.61 years (range 19-65). Injuries at or above the confluence (Strasberg-Bismuth ≥ E3) occurred in 25% of cases (2). Primary repair was performed in two cases. Half of the cases underwent a Hepp-Couinaud laterolateral RYHJ, while three patients received a terminolateral RYHJ, and one underwent a bi-terminolateral RYH. The mean operative time was 260 min (range 120-360). Overall morbidity was 37.5% (3 cases): two minor complications (bile leak grade A and drainage-related bleeding) and one major complication (bile leak grade C). No mortality was recorded. The maximum follow-up period reached 26 months (range 6-26). CONCLUSIONS: Our study demonstrates the feasibility of laparoscopic RYHJ in a selected group of patients, offering the benefits of a minimally invasive approach.

Desarrollo de una Unidad de Cirugía Hepatobiliar Compleja y Trasplante Hepático en un hospital público: a una década de su formación / Development of a complex hepatobiliary surgery and liver transplantation unit in a public hospital: a decade after its creation

RESUMEN Antecedentes: concentrar esta patología hepatobiliar en centros especializados puede permitir bajas cifras de morbimortalidad y mejores resultados alejados. Objetivo: describir las características clínico-patológicas y los resultados de una serie de pacientes operados en los primeros 10 años de una Unidad de Cirugía Hepatobiliar Compleja y Trasplante Hepático (TH), así como la actividad científica y docente de sus integrantes. Materiales y métodos: estudio retrospectivo descriptivo. Se recopiló información de una base de datos prospectiva. Se clasificaron los procedimientos según su complejidad y se analizaron los TH, las hepatectomías y los procedimientos biliares complejos, realizados entre 2013 y 2022. Resultados: sobre 1440 procedimientos quirúrgicos, 832 fueron de alta complejidad (58%). Se realizaron 452 trasplantes hepáticos (TH), 14 (3%) de ellos hepatorrenales; la sobrevida global del trasplante fue de 83%, 77% y 75% a 1, 3 y 5 años, respectivamente. La falla primaria del injerto se observó en 5 casos (1,1%). Se efectuaron 254 hepatectomías: 58 (23%) por patología benigna, 155 (61%) por patología maligna y 41 (16%) en donante vivo relacionado para TH. La morbilidad total fue del 27% y la mortalidad intrahospitalaria de 2%. Se efectuaron 106 derivaciones biliodigestivas: 53 en pacientes con lesión quirúrgica de la vía biliar. La morbilidad a 30 días fue del 42%, en su mayoría complicaciones menores (28%). Además, se realizaron 17 duodenopancreatectomías cefálicas y 3 esplenopancreatectomías. Se realizaron múltiples publicaciones, presentaciones y cursos, y desde 2015 se implementó una residencia posbásica de la especialidad. Conclusión: la concentración de patología hepatobiliar en un centro de alta complejidad permitió alcanzar resultados satisfactorios, comparables con series extranjeras.

ABSTRACT Background: Centralizing hepatobiliary disease in specialized centers can reduce morbidity and mortality rates and improve long-term outcomes. Objective: The aim of the present study was to describe the clinical and pathological features and surgical outcomes of a series of patients operated on in the Hepatobiliary Surgery and Liver Transplantation Unit of Hospital El Cruce during its first 10 years, as well as the scientific and educational activity of its members. Material and methods: We conducted a descriptive and retrospective study. The information was retrieved from a prospective database. The procedures were classified according to their complexity. An analysis was conducted on liver transplantations (LTs), liver resections and complex biliary procedures, performed from 2013 to 2022. Results: Of 1449 surgical procedures, 832 were high-complexity interventions (58%). A total of 452 LTs were performed, 14 (3%) were combined liver and kidney transplantations; overall transplant survival was 83%, 77% and 75% at 1, 3 and 5 years, respectively. Primary graft dysfunction was observed in 5 cases (1.1%). There were 254 liver resections; 58 cases (23%) were related to benign liver diseases, 155 (61%) to malignancies, and 41 (16%) were associated with living donor transplants. Overall morbidity was 27% and in-hospital mortality was 2%. A total of 106 bilio-digestive bypass procedures were carried out, 53 in patients with bile duct injury. Thirty-day morbidity was 42%, and most cases were minor complications (28%). Other procedures included 17 cephalic pancreaticoduodenectomies and 3 splenectomies and distal pancreatectomies. We have published numerous papers, delivered presentations and courses, and implemented a fellowship program in the specialty since 2015. Conclusion: Centralizing hepatobiliary diseases at a high-complexity center led to comparable outcomes with those reported in international series.

[Cholecystocolonic fistula as a complication of advanced gallbladder cancer] / [Fístula colecistocolónica como complicación de cáncer de vesícula avanzado]

Cholecystocolonic fistula (CCF) is the second most common cholecystoenteric fistula, associated in most cases with stone disease. Symptoms are usually minimal or nonspecific, and preoperative diagnosis is uncommon. Although the incidence of FCC caused by gallbladder cancer comprises 1.7% of cases, it is necessary to suspect it in order to adopt the best therapeutic strategy.

La fístula colecistocolónica (FCC) es la segunda fístula colecistoentérica más común, asociada en la mayoría de los casos a enfermedad litiásica. Los síntomas suelen ser mínimos o inespecíficos, siendo infrecuente su diagnóstico preoperatorio. Si bien la incidencia de FCC causada por cáncer de vesícula biliar comprende el 1,7 % de los casos, es necesario sospecharla para adoptar la mejor estrategia terapéutica.