Asunto(s)
Eventración Diafragmática/complicaciones , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Insuficiencia Respiratoria/etiología , Diagnóstico Diferencial , Eventración Diafragmática/diagnóstico , Humanos , Lactante , Masculino , Tomografía de Emisión de Positrones , Insuficiencia Respiratoria/diagnóstico , Tomografía Computarizada por Rayos XAsunto(s)
Traumatismos Abdominales/complicaciones , Obstrucción Intestinal/etiología , Pelvis Renal/anomalías , Obstrucción Ureteral/complicaciones , Heridas no Penetrantes/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/cirugía , Accidentes por Caídas , Niño , Medios de Contraste/administración & dosificación , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hematoma/terapia , Humanos , Hidronefrosis/complicaciones , Hidronefrosis/congénito , Hidronefrosis/diagnóstico por imagen , Hallazgos Incidentales , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Pelvis Renal/lesiones , Pelvis Renal/cirugía , Masculino , Espacio Retroperitoneal , Medición de Riesgo , Tomografía Computarizada por Rayos X/métodos , Obstrucción Ureteral/congénito , Urografía , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/cirugíaRESUMEN
BACKGROUND: Laparoscopic cholecystectomy is associated with a higher incidence of bile duct injury than open cholecystectomy. This study reviews the management of bile duct injury in a tertiary hepatobiliary unit. METHODS: From 1991 to 1995, 27 patients (18 women) of median age 49 (range 25-67) years were referred to this unit with bile duct injury following elective laparoscopic cholecystectomy. Laparoscopic cholecystectomy was described as 'uneventful' in 14 and 'difficult' in 13 patients; six injuries were recognized at operation. RESULTS: Patients were transferred a median of 26 (range 0-990) days after laparoscopic cholecystectomy, although initial symptoms were recorded a median of 3 (range 0-700) days after cholecystectomy. Fifteen patients underwent additional surgery before referral. Management before referral included surgical exploration (15 patients), endoscopic cholangiography (ERC) and stent insertion (three), external drainage of bile collections (five), and conservative management (five). Management after referral included surgical reconstruction (19 patients), laparotomy with drainage (one), percutaneous drainage (two), ERC and stent insertion (two), percutaneous cholangiography with dilatation and stent placement (three), and conservative management (two). One patient died and the median inpatient stay following referral was 14 (range 7-78) days. Ten of 15 patients who had surgery before referral required a further biliary reconstruction. After median follow-up of 30 (range 3-60) months, four of nine patients with complex high injuries continue to have episodes of cholangitis and one patient has developed secondary biliary cirrhosis. CONCLUSION: Bile duct injury following laparoscopic cholecystectomy is a complex management problem and results in significant postoperative morbidity. Most patients referred after attempted repair require further reconstructive surgery, and patients with complex high injuries have a risk of long-term morbidity.