Colecistectomía por técnica de mínimo acceso

Se realizó un estudio descriptivo prospectivo de corte transversal en pacientes que fueron colecistectomizados por técnica de mínimo acceso con incisión vertical en el Hospital Provincial Clínico Quirúrgico de Sancti Spíritus a partir de Febrero de 1999, con el objetivo de determinar la efectividad de la colecistectomía por técnica de mínimo acceso en pacientes operados de afecciones de la vesícula biliar, apareciendo que el sexo femenino resultó mayoritariamente afectado por la patología de la vesícula biliar (86,34 porciento), fundamentalmente los grupos etáreos de 31-45 y 46-60 años de edad. El 76,65porciento de los pacientes fueron intervenidos con anestesia espinal en un tiempo menor de 60 minutos para el 92,96porciento de los enfermos; sólo el 2,34porciento de La muestra presentó complicaciones a pesar de que la mayor parte de los pacientes fueron intervenidos por cirujanos más jóvenes (61,32porciento). Pudimos apreciar que de los 256 pacientes intervenidos en 232 (90,62porciento) se logró realizar la colecistectomía por una incisión entre 3-5 cm, mientras que sólo fue necesario ampliar la incisión en 3 pacientes (1,17porciento). Sólo se reportó una complicación transoperatoria lo cual consistió en una quemadura con el electrocauterio de un asa intestinal por lo que fue necesario reintervenir a la paciente. El 93,75porciento de los pacientes fueron egresados antes de las 24 horas de haber sido operados y sólo 2 pacientes (0,72porciento) necesitaron ingresos por más de 72 horas por complicaciones(AU)

We made a descriptive prospective cross-sectional study in patients that were colecystectomized by a minimum access technique with a vertical incision in the Provincial Clinical Surgical Hospital of Sancti Spíritus starting from February of 1999, with the objective of assessing the effectiveness of colecystectomy by a minimum access technique in patients operated on affections of the gall bladder. The results show that the female sex was for the most part affected by the pathology of the gall bladder (86.34)percent, fundamentally the age groups of 31-45 and 46-60 years of age. 76.65 percent of the patients was operated with spinal anesthesia in less than 60 minutes for 92.96percent of the patients. 2.34percent of the sample only presented complications although most of the patients was operated by younger surgeons (61.32percent). We could appreciate that of the 256 patients operated in 232 (90.62)percent the colecystectomy could be made by an incision of 3-5 cm, while it was only necessary to enlarge the incision in 3 patients(1.17percent). Only a transoperative complication was reported which consisted of a burn of an intestinal loop with the electrocautery , therefore it was necessary to reoperate the patient. 93.75percent of the patients were discharged before 24 hours postoperation and only 2 patients (0.72percent) needed admissions for more than 72 hours due to complications(AU)

A randomized controlled trial comparing cholecystocholangiography with cystic duct cholangiography during laparoscopic cholecystectomy.

BACKGROUND: The rate of intraoperative cholangiography fell after the advent of laparoscopic cholecystectomy due to the perceived difficulty of cystic duct cannulation. It is suggested that cholecystocholangiography (CCC) is a valid and easier alternative. The present study compares cystic duct cholangiography (CDC) to CCC with evaluation of procedural time, success rate, image quality, cost and radiation exposure. METHODS: Patients undergoing laparoscopic cholecystectomy were randomized to CCC (n = 40) or CDC (n = 36). Details of operative times, radiation exposure, and use of disposable equipment were recorded prospectively. Cholangiograms were performed using image intensification and were scored from 0 to 6 according to adequacy of images. Data were analysed on an intention-to-treat basis with the chi-squared test, t-test or Fisher's exact test. RESULTS: The success rate for CDC was 100% and for CCC it was 72% (P = 0.0005). Patients with a failed CCC went on to have CDC for a success rate in the CCC arm of 92.5%. Comparing CDC to CCC, there was no significant difference in cost ($30.16 vs $33.36: P = 0.11), operative time (1 h 13 min vs 1 h 3 min; P = 0.19) or cholangiogram time (8 vs 9 min: P = 0.39). There was a significant difference in screening time (0:41 vs 1:33 min; P < 0.0001), adequate image quality (100 vs 72.5%, P = 0.0005) and procedure-related complications (0 vs 5; P = 0.03). CONCLUSIONS: A significant number of CCC fail. Successful CCC provides inferior image quality and greater radiation exposure. It provides no benefit in time or cost and cannot be recommended for operative cholangiography.

Colecistocolangiografía transhepática percutánea (C.C.T.H.P.) en pediatría / Percutaneous transhepatic cholecysto-cholangiography in children

La colestasis en pediatría, requiere en algunos casos, de una buena opacificación de la vía biliar para conocer su etiología, aún en ausencia de dilatación de los conductos biliares. En 29 niños, entre 50 días y 15 años, con colestasis clínica y/o humoral, se realizó, bajo guía ecográfica colecistocolangiografía transhepática percutánea, sin complicaciones significativas. Once fueron normales, 7 presentaron colangitis esclerosante, 4 litiasis biliar; en 3 de ellos con litiasis primaria el procedimiento fue terapéutico; 3 canal común, 1 atresia de vías biliares y 2 amputación de la vía biliar. En un paciente no se opacificó la vía biliar satisfactoriamente (AU)

Colecistocolangiografía transhepática percutánea (C.C.T.H.P.) en pediatría / Percutaneous transhepatic cholecysto-cholangiography in children

La colestasis en pediatría, requiere en algunos casos, de una buena opacificación de la vía biliar para conocer su etiología, aún en ausencia de dilatación de los conductos biliares. En 29 niños, entre 50 días y 15 años, con colestasis clínica y/o humoral, se realizó, bajo guía ecográfica colecistocolangiografía transhepática percutánea, sin complicaciones significativas. Once fueron normales, 7 presentaron colangitis esclerosante, 4 litiasis biliar; en 3 de ellos con litiasis primaria el procedimiento fue terapéutico; 3 canal común, 1 atresia de vías biliares y 2 amputación de la vía biliar. En un paciente no se opacificó la vía biliar satisfactoriamente

La colangiografía transcística durante la colecistectomía laparoscópica / Cystic duct cholangiography during laparoscopic cholecystectomy

En 10 meses se realizaron 95 colecistectomías laparoscópicas, intentándose en todos los casos la colangiografía transcística. En 90 casos (94.7%) fue posible visualizar radiológicamente la vía biliar. En cuatro casos no, por presentar un conducto cístico fino y escleroso y en el restante por haberse seccionado el mismo en forma inadvertida. No hubo complicaciones relacionadas con la técnica de cateterización. El tiempo promedio para realizarla fue de 20 minutos. Se diagnosticaron 4 litiasis coledocianas insospechadas (4.4%) en pacientes sin factores predictivos de esta patología. Ambos se resolvieron convirtiendo la operación. No hubo ninguna lesión biliar. La colangiografía intraoperatoria en la colecistectomía laparoscópica, es posible de realizar en la mayoría de los casos, aportando datos muy importantes que hacen a esta cirugía más segura y completa. Esto nos inclina a aconsejar la realización sistemática de la colangiografía en el transcurso de la colecistectomía laparoscópica

La colangiografía transcística durante la colecistectomía laparoscópica / Cystic duct cholangiography during laparoscopic cholecystectomy

En 10 meses se realizaron 95 colecistectomías laparoscópicas, intentándose en todos los casos la colangiografía transcística. En 90 casos (94.7%) fue posible visualizar radiológicamente la vía biliar. En cuatro casos no, por presentar un conducto cístico fino y escleroso y en el restante por haberse seccionado el mismo en forma inadvertida. No hubo complicaciones relacionadas con la técnica de cateterización. El tiempo promedio para realizarla fue de 20 minutos. Se diagnosticaron 4 litiasis coledocianas insospechadas (4.4%) en pacientes sin factores predictivos de esta patología. Ambos se resolvieron convirtiendo la operación. No hubo ninguna lesión biliar. La colangiografía intraoperatoria en la colecistectomía laparoscópica, es posible de realizar en la mayoría de los casos, aportando datos muy importantes que hacen a esta cirugía más segura y completa. Esto nos inclina a aconsejar la realización sistemática de la colangiografía en el transcurso de la colecistectomía laparoscópica

Hepatología nuclear

For many years the liver and spleen scan has been the study more frequently used by nuclear medicine, however recent advances in the functional evaluztion of the liver through the use of newer isotopes, make the colloid scan less useful. The real progress in nuclear medicine occurs in 1982 with the introduction of the iminodiacetic derivatives (HIDA) tagged with 99mTc. The initial compounds have several important limitations such as the hepatic function and the bilirubin levels, that now with the most recent derivatives such as the mebromofenin (TMB) became less important. This compound has many advantages such as high hepatic concentration (98.1 percent), rapid excretion (ti/2:16 minutes) and great resistance to displacement by bilirubin (70 percent with levels above 20 mgpercent). All these reasons make TMB the ideal agent to study the hepatobiliary physiology. HIDA scan is the most reliable of all the imaging modalities available in the diagnosis of acute cholecystitis with a sensitivity of 92-100 percent, and a specificity of 95-98 percent. The diagnosis of chronic cholecystitis is also simple by this method. Other indications of the HIDA scan is in the study of biliary obstructions, evaluation of biliodigestive anastomosis, biliary fistulas, hepato-biliary ruptures and congenital abnormalities such as choledochal cysts. One of the most important aspect of this technic, is the ability to study hepatic function through the use of the computer and special curves, that allows a direct evaluation of the different steps of hepatic function (uptake, excretion). The function of the transplanted liver can be evaluated this way, and modern Hepatology consider this modality as a very important diagnostic tool.

Oral cholecystography: comparison of conventional screen-film with photostimulable imaging plate radiographs.

Oral cholecystography was performed on ultrasonically proven cases of cholelithiasis. The conventional screen/film system and computed radiography (CR) using the imaging plate were used under practically identical conditions. The diagnostic accuracy of the two techniques was assessed objectively, and the image quality was assessed subjectively. The CR image proved to be better than the conventional screen/film image, even with the low-dose exposure. This paper describes our experience in the area of the biliary tract system with CR - a digital radiographic system using photostimulable phosphor.

[Interventional radiology in non-neoplastic diseases of the biliary tract. A report on 93 personal cases]. / La radiologia interventistica nelle malattie non neoplastiche delle vie biliari. Rapporto su 93 casi personali.

Most references in the literature on interventional radiology of the biliary tract refer to the treatment of cancer; only occasionally are benign conditions mentioned. An updated list of useful radiosurgical instruments on the market in Italy is presented. The operating technique from the preparation of the patient to the performance of percutaneous transhepatic cholangiography (PTC), biliary drainage, transhepatic bilioplasty, percutaneous extraction and chemical cholelitholisis of biliary calculi and drainage of biliary collections is then described. A personal series is then presented. It consists of 93 patients in whom one or more of the following conditions were diagnosed: exclusively intrahepatic calculosis (3 cases), calculosis of the common bile duct (23 percutaneous treatments), empyema of the gallbladder (6 cases), suppurating cholangitis (46 cases), sclerotic or inflammatory stenosis (16 cases), biliary collections (14 cases). Results are reported and commented on.

[Possibilities of short-time tomosynthesis]. / Möglichkeiten der Kurzzeittomosynthese.

Short-term tomosynthesis enables continuous analysis of structures which appear interesting. The results of short-term tomosynthesis were compared with those of plain roentgenography and conventional tomography. Short-term tomosynthesis appears as an alternative to spot-film radiography and as a complement to tomography in the analysis of spatially limited regions. It facilitates orientation in space and free projection of oblique structures. Good results were obtained in examinations of the pyramids (auditory canal and mandibular joint), the paranasal sinuses, the cervical vertebral column, the extremities and their joints. Examination of soft tissues was usually not very promising in view of the conditions under which tomosynthesis was performed. The same applied likewise to the infusion cholecystocholangiogram and the infusion urogram. Technical improvements will certainly bring about an extension of the uses of this method.

Thin needle percutaneous transhepatic cholangiography - historical review.

In this review, the historical background of the development of the thin needle technique for percutaneous transhepatic cholangiography is described. History goes back to 1921 when cholangiography was first attempted via the gallbladder in Germany. Despite the subsequent progress, frequent bile leakage necessitated a turn to the transhepatic technique which was vastly improved by the introduction of the TV monitoring system. Finally, the development and refinement of the technique for percutaneous transhepatic cholangiography which occurred mainly in Japan, particularly at the Chiba University Hospital, first in the hands of surgeons and then internists, is detailed with references.

Application of radiographic magnification technique with an ultra-high-speed rare-earth screen/film system to oral cholecystography.

2X magnification employing a 200-mu focal spot and an Alpha 8-XM screen/film system was applied to oral cholecystography and the results compared with those for the conventional contact technique with the Par-RP system. The basic imaging properties of the system, as well as phantom studies, indicated that the image quality obtained with magnification is comparable to or better than that for the conventional technique. In clinical studies on the detection of gallstones, the conventional technique revealed 5 true-positive and 17 true-negative cases and 1 false-positive and 2 false-negative cases, while the magnification technique provided 7 true-positive and 18 true-negative cases but no false cases. With the magnification technique the skin dose was reduced to approximately half that for the conventional contact technique.