ABSTRACT
BACKGROUND: There is no standard nor widely accepted way of reporting outcomes of treatment of biliary injuries. This hinders comparison of results among approaches and among centers. This paper presents a proposal to standardize terminology and reporting of results of treating biliary injuries. METHODS: The proposal was developed by an international group of surgeons, biliary endoscopists and interventional radiologists. The method is based on the concept of "patency" and is similar to the approach used to create reporting standards for arteriovenous hemodialysis access. RESULTS: The group considered definitions and gradings under the following headings: Definition of Patency, Definition of Index Treatment Periods, Grading of Severity of Biliary Injury, Grading of Patency, Metrics, Comparison of Surgical to Non Surgical Treatments and Presentation of Case Series. CONCLUSIONS: A standard procedure for reporting outcomes of treating biliary injuries has been produced. It is applicable to presenting results of treatment by surgery, endoscopy, and interventional radiology.
Subject(s)
Bile Ducts/surgery , Biliary Tract Surgical Procedures/classification , Endoscopy, Digestive System/classification , Radiography, Interventional/classification , Terminology as Topic , Wounds and Injuries/therapy , Bile Ducts/diagnostic imaging , Bile Ducts/injuries , Biliary Tract Surgical Procedures/standards , Consensus , Endoscopy, Digestive System/standards , Humans , Radiography, Interventional/standards , Severity of Illness Index , Treatment Outcome , Wounds and Injuries/diagnostic imagingSubject(s)
Ambulatory Surgical Procedures/classification , Biliary Tract Surgical Procedures/classification , Cholangiography/classification , Current Procedural Terminology , Forms and Records Control/standards , Radiology, Interventional/classification , Ambulatory Surgical Procedures/economics , Bile Ducts, Intrahepatic/surgery , Biliary Tract/anatomy & histology , Biliary Tract/physiopathology , Biliary Tract Surgical Procedures/economics , Catheterization , Cholangiography/economics , Drainage , Humans , Insurance Claim Reporting , Radiology, Interventional/economics , Stents , United StatesSubject(s)
Biliary Tract Surgical Procedures/adverse effects , Cholangitis/etiology , Common Bile Duct Diseases/surgery , Metals , Sphincter of Oddi/surgery , Stents , Biliary Tract Surgical Procedures/classification , Biliary Tract Surgical Procedures/instrumentation , Cholangitis/physiopathology , Common Bile Duct Diseases/physiopathology , Humans , Risk Factors , Sphincter of Oddi/physiopathologyABSTRACT
Presentamos una serie de 17 pacientes con cirrosis hepatica asociada a una litiasis biliar; 14 fueron operados y 3 recibieron un gesto endoscópico. Se lo dividió en 5 grupos: I)con litiasis vesicular (6 casos). II) con litiasis vesicular y de la via biliar principal con colestasis extrahepática (4 casos). III)con litiasis vesicular y de la vía biliar principal con pancreatitis aguda (3 casos). IV)con litiasis residual y colangitis aguda (1 caso operado de urgencia) y V)con litiasis vesicular y de la vía biliar principal con colestasis extrahepática y tratados por vía endoscópica (3 casos). Fueron considerados la bilirrubinemia, la albuminemia y la protrombinemia para evaluar la funcionalidad hepática y el pronóstico. La mortalidad del 23,5%(4 casos), falleciendo 3 de los 4 pacientes colestáticos operados en período electivo y el paciente intervenido de urgencia (Grupo II y IV). Ello evidencia la gravedad de la colestasis extrahepática y de la cirugía de urgencia en los pacientes cirróticos. La papilotmía endoscópica constituye el mejor método terapéutico en los pacientes cirróticos con litiasis de la vía biliar principal y colestasis extrahepática
Subject(s)
Biliary Tract Surgical Procedures/statistics & numerical data , Cholelithiasis/epidemiology , Liver Cirrhosis/epidemiology , Severity of Illness Index , Biliary Tract Surgical Procedures/classification , Biliary Tract Surgical Procedures/mortality , Bilirubin/blood , Cholangitis/etiology , Cholangitis/surgery , Cholecystectomy/statistics & numerical data , Cholelithiasis/complications , Cholelithiasis/diagnosis , Liver Cirrhosis/surgery , Liver Cirrhosis/complications , Pancreatitis/etiology , Pancreatitis/surgery , Prothrombin , Serum AlbuminABSTRACT
Presentamos una serie de 17 pacientes con cirrosis hepatica asociada a una litiasis biliar; 14 fueron operados y 3 recibieron un gesto endoscópico. Se lo dividió en 5 grupos: I)con litiasis vesicular (6 casos). II) con litiasis vesicular y de la via biliar principal con colestasis extrahepática (4 casos). III)con litiasis vesicular y de la vía biliar principal con pancreatitis aguda (3 casos). IV)con litiasis residual y colangitis aguda (1 caso operado de urgencia) y V)con litiasis vesicular y de la vía biliar principal con colestasis extrahepática y tratados por vía endoscópica (3 casos). Fueron considerados la bilirrubinemia, la albuminemia y la protrombinemia para evaluar la funcionalidad hepática y el pronóstico. La mortalidad del 23,5%(4 casos), falleciendo 3 de los 4 pacientes colestáticos operados en período electivo y el paciente intervenido de urgencia (Grupo II y IV). Ello evidencia la gravedad de la colestasis extrahepática y de la cirugía de urgencia en los pacientes cirróticos. La papilotmía endoscópica constituye el mejor método terapéutico en los pacientes cirróticos con litiasis de la vía biliar principal y colestasis extrahepática
Subject(s)
Comparative Study , Biliary Tract Surgical Procedures/statistics & numerical data , Liver Cirrhosis/epidemiology , Cholelithiasis/epidemiology , Severity of Illness Index , Biliary Tract Surgical Procedures/mortality , Biliary Tract Surgical Procedures/classification , Liver Cirrhosis/complications , Liver Cirrhosis/surgery , Cholelithiasis/complications , Cholelithiasis/diagnosis , Cholecystectomy/statistics & numerical data , Pancreatitis/etiology , Cholangitis/etiology , Pancreatitis/surgery , Cholangitis/surgery , Serum Albumin , Prothrombin , Bilirubin/bloodABSTRACT
Los recientes avances en el manejo de este problema quirúrgico han cambiado por completo el grave pronóstico que antiguamente se le atribuía. El artículo revisa conceptos actuales en Atresia Biliar y presenta las últimas cifras del Registro Americano de Atresia Biliar