RESUMEN
OBJECTIVES: The authors sought to check the frequency of biliary complications with the use of a T-tube. In 2012, throughout the year, it was carried out systematically in all liver transplantations regardless of the characteristics of the bile duct. Despite the long experience, biliary complications remain a common cause of postoperative morbidity and mortality. MATERIAL AND METHODS: In this study we compared complications in 23 consecutive transplantation cases using T-tube biliary anastomosis during the year 2012 with 23 consecutive transplantation cases without T-tube during the year 2013. We evaluated postoperative complications and long-term outcomes (for 2 years to 3 years). RESULTS: Of the 23 patients with anastomosis with a T-tube, 2 patients (8.69%) had biliary stricture that required prosthesis by endoscopic retrograde cholangiopancreatography, 1 of them (4.34%) was operated by incorrect placement of the T-tube, and in 4 patients (17.39%) bile leakage (endoscopic retrograde cholangiopancreatography prostheses in 3 cases and hepaticojejunostomy in 1). During follow-up at 3 years, only 2 patients had minimal bile duct dilatation without clinical relevance. In the patients who underwent transplantation without a T-tube, 18 (78.26%) had no complications, 3 (13.04%) showed stenosis (prosthesis placement), and 2 (8.69%) had bile leakage (hepaticojejunostomy and prosthesis). During follow-up at 2 years to 3 years, no patient had biliary dilatation or alteration of cholestatic parameters. In the comparative study of both groups we found no statistically significant differences. CONCLUSIONS: We have not seen an improvement in complications with the use of T-tube (69.56% vs. 78.23%) that encourage us to work systematically, although the small number of cases does not allow statistically significant conclusions.
Asunto(s)
Conductos Biliares/cirugía , Trasplante de Hígado/efectos adversos , Anastomosis Quirúrgica , Enfermedades de las Vías Biliares/etiología , Enfermedades de las Vías Biliares/cirugía , Procedimientos Quirúrgicos del Sistema Biliar/instrumentación , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestasis/etiología , Constricción Patológica/etiología , Constricción Patológica/cirugía , Femenino , Humanos , Trasplante de Hígado/instrumentación , Trasplante de Hígado/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , StentsRESUMEN
OBJECTIVES: The authors sought to identify strictures or hepatic artery obstruction with posterior collateral transformation in our series of liver transplantation, treatment, and evolution. The thrombosis or severe hepatic artery stenosis sometimes presents a compensation mechanism, the collateral transformation of the artery. MATERIAL AND METHODS: From April 2002 to December 2011 we collected 18 cases of collateral transformation. We analyzed data regarding the transplantation, diagnosis, treatment, clinical evolution, liver function, and Doppler-ultrasound. RESULTS: The main indication was alcoholic cirrhosis, followed by hepatocellular carcinoma - hepatitis C virus. The mean cold ischemia time was 292.2 minutes mean hot ischemia was 48.8. The anastomosis was performed on the gastroduodenal-splenic patch donor in 14 cases, the celiac trunk in 2 cases, and on grafts to the aorta in another 2. Doppler ultrasound showed 8 cases without complications, 8 with low flows, and 2 cases with alterations of the right hepatic artery. Computed tomographic (CT) angiography was performed in patients with impaired eco-Doppler and found 4 obstructions, 2 cases with kinking, 1 stenosis, and 3 normal cases. Three patients with low flows were re-operated and another re-transplanted. After diagnosis of collateral transformation, all were treated with antiplatelet agents. Two cases of angioplasty were associated. The collaterals were diagnosed 1 month to 44.8 months after transplantation. Five patients died. In the latest data, 10 patients do not have analytical alteration. The Doppler ultrasound shows 7 cases being normal and 6 with flow but low resistances. CONCLUSIONS: In our series, all patients with collateral transformation, except one who was transplanted, maintain good liver function with permeable vessels.
Asunto(s)
Circulación Colateral/fisiología , Arteria Hepática , Trasplante de Hígado/efectos adversos , Trombosis/fisiopatología , Carcinoma Hepatocelular/fisiopatología , Carcinoma Hepatocelular/cirugía , Arteria Celíaca/cirugía , Angiografía por Tomografía Computarizada , Constricción Patológica/diagnóstico por imagen , Constricción Patológica/etiología , Constricción Patológica/cirugía , Ecocardiografía Doppler , Hepatitis C Crónica/fisiopatología , Hepatitis C Crónica/cirugía , Humanos , Cirrosis Hepática Alcohólica/fisiopatología , Cirrosis Hepática Alcohólica/cirugía , Neoplasias Hepáticas/fisiopatología , Neoplasias Hepáticas/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Trombosis/diagnóstico por imagen , Trombosis/etiología , Donantes de TejidosAsunto(s)
Perforación del Esófago/patología , Enfermedades del Mediastino/patología , Anciano , Endoscopía del Sistema Digestivo/métodos , Perforación del Esófago/diagnóstico por imagen , Perforación del Esófago/cirugía , Esófago/diagnóstico por imagen , Esófago/patología , Esófago/cirugía , Humanos , Masculino , Enfermedades del Mediastino/diagnóstico por imagen , Enfermedades del Mediastino/cirugía , RadiografíaRESUMEN
No disponible
Asunto(s)
Humanos , Neoplasias Pancreáticas/cirugía , Carcinoma de Células de los Islotes Pancreáticos/cirugía , Carcinoma Ductal Pancreático/cirugía , Atención Perioperativa/métodos , Pancreatectomía/métodosRESUMEN
No disponible
Asunto(s)
Humanos , Carcinoma Hepatocelular/cirugía , Neoplasias Hepáticas/cirugía , Análisis de Intención de Tratar , Selección de Paciente , Hepatectomía , Trasplante de HígadoRESUMEN
A case of biliary ascaridiasis is presented in which biliary obstruction and pancreatitis were diagnosed. Recovery followed surgical removal of the worms. The literature is reviewed.
Asunto(s)
Ascaridiasis/diagnóstico , Colestasis Extrahepática/diagnóstico , Enfermedades del Conducto Colédoco/diagnóstico , Abdomen Agudo/diagnóstico , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Anciano , Ascaridiasis/complicaciones , Ascaridiasis/cirugía , Colecistitis/diagnóstico , Colecistitis/cirugía , Colestasis Extrahepática/etiología , Colestasis Extrahepática/cirugía , Enfermedades del Conducto Colédoco/etiología , Enfermedades del Conducto Colédoco/cirugía , Diagnóstico Diferencial , Humanos , Enfermedades del Íleon/complicaciones , Enfermedades del Íleon/diagnóstico , Enfermedades del Íleon/cirugía , Parasitosis Intestinales/complicaciones , Parasitosis Intestinales/diagnóstico , Parasitosis Intestinales/cirugía , MasculinoAsunto(s)
Tumor Carcinoide/diagnóstico , Enfermedades del Íleon/diagnóstico , Neoplasias del Íleon/diagnóstico , Obstrucción Intestinal/diagnóstico , Enfermedad Aguda , Tumor Carcinoide/complicaciones , Humanos , Enfermedades del Íleon/etiología , Neoplasias del Íleon/complicaciones , Obstrucción Intestinal/etiología , Masculino , Persona de Mediana EdadRESUMEN
A case of acute abdominal hemorrhage caused by the rupture of several aneurysms of the pancreatoduodenal artery is presented. We discuss the difficulties of the diagnosis and point out the importance of the arteriographic study, as always in vascular lesions. We emphasize the difficulties of the treatment; most cases require surgical approach, going from suture of the aneurysm to cephalic duodenopancreatectomy.
Asunto(s)
Abdomen Agudo/etiología , Aneurisma/complicaciones , Aneurisma/cirugía , Duodeno/irrigación sanguínea , Hemoperitoneo/etiología , Humanos , Masculino , Persona de Mediana Edad , Páncreas/irrigación sanguínea , Rotura EspontáneaRESUMEN
We have reviewed our experience with 2,430 cases of lithiasis of the biliary tract, 500 of them located in the common bile duct and 104 corresponding to residual lithiasis. We have made a general reflexion on the problems aroused by this very common al condition, which has an imprevisible, some times severe, outcome. The recent acquisition of new conservative methods, as disolvents and lithotrix, and the diagnostic and therapeutic role of endoscopy have revolutionated the state of the art and have introduced controversial points still unsolved. As it is common in clinical practice, biliary lithiasis should be approached in a multidisciplinary fashion, employing the most convenient diagnostic procedure for the clinical situation of the patient; a priori no accredited procedure should be disregarded.