Colecistectomía laparoscópica subtotal como alternativa quirúrgica segura en casos complejos

Jara, Génesis; Rosciano, José; Barrios, Wuendys; Vegas, Liumariel; Rodríguez, Omaira; Sánchez, Rebeca; Sánchez, Alexis

doi:10.1016/j.ciresp.2017.07.013

Cited by 16 publications

(13 citation statements)

References 20 publications

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“…Subtotal cholecystectomy is being performed as a damage control operation for a difficult gall bladder. The incidence reported from large series varies from 0.4% to 3% 13567812. Although many reports have shown the safety of this procedure,1212 but only a few have described the short and long term complications associated with it 356.…”

Section: Discussionmentioning

confidence: 99%

“…It not only avoids the difficult calots dissection in the setting of inflammation but also keeps the dissection away from bile duct and hepatic artery 12345. However, such a strategy has been reported to increase the risk of bile leak 3456. More so, it also leaves some amount of the gall bladder (GB) attached to the biliary tree.…”

Section: Introductionmentioning

confidence: 99%

“…More so, it also leaves some amount of the gall bladder (GB) attached to the biliary tree. This diseased portion of this remnant gall bladder is prone to develop recurrent stones 345678910…”

Section: Introductionmentioning

confidence: 99%

“…However, the natural history of the residual gall bladder stump after partial cholecystectomy is not clearly understood. About 10% develop symptoms and seek medical advice 1356. There is a paucity of literature regarding the management and outcome of recurrent lithiasis in the gall bladder stump after cholecystectomy 7891011.…”

Section: Introductionmentioning

confidence: 99%

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Residual gall bladder: An emerging disease after safe cholecystectomy

Gupta

Sharma

Kumar

et al. 2019

Ann Hepatobiliary Pancreat Surg

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Backgrounds/AimsResidual gallbladder mucosa left after subtotal/partial cholecystectomy is prone to develop recurrent lithiasis and become symptomatic, which mandates surgical removal.MethodsWe retrospectively evaluated the patients with residual gallbladder referred to us from January 2011 to December 2017. Based on MRCP we classified calot's anatomy to – type I where cystic duct was seen and type II where sessile GB stump was seen.Results21 patients with median age 38 years and M:F::1:9.5, had undergone cholecystectomy (3 months-20 years) prior, presented with recurrent biliary pain. 3 had jaundice (CBD stone, Mirizzi and biliary stricture), 1 had pancreatitis and one had malignancy of the GB. Imaging revealed type I anatomy in 14 (67%) and type II in 7 (33%). All underwent completion cholecystectomy – open in 18 and laparoscopic in 3 (one converted to open). Additional procedure was required in 5 patients – CBD exploration in 2 (10%) and one each Hepatico-jejunostomy, extended cholecystectomy and splenectomy. Median hospital stay was 1 day. There was no mortality and 10% morbidity. One patient with malignancy died at 2 years, two died of unrelated cause, one developed incisional hernia and the remaining were well at a median follow up of 29 months.ConclusionsResidual GB lithiasis should be suspected if there are recurrent symptoms after cholecystectomy. MRCP based proposed classification can guide the management strategy. Completion cholecystectomy is curative.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Residual gall bladder: An emerging disease after safe cholecystectomy

Gupta

Sharma

Kumar

et al. 2019

Ann Hepatobiliary Pancreat Surg

View full text Add to dashboard Cite

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“…In order to decrease risk of iatrogenic injuries, intraoperative conversion from laparoscopic cholecystectomy to open cholecystectomy is required in 1.9–7.5% of patients due to either (a) severely inflamed, gangrenous or perforated acute cholecystitis or (b) challenging surgery because of inadequate anatomic landmarks, adhesions or intraoperative bleeding. In the same situations, open or laparoscopic subtotal cholecystectomy is a valid alternative option [ 23 , 24 ].…”

Section: Cholecystectomy: Techniques and Indicationsmentioning

confidence: 99%

Early cross-sectional imaging following open and laparoscopic cholecystectomy: a primer for radiologists

Tonolini

Ierardi²,

Patella³

et al. 2018

Insights Imaging

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Performed on either an elective or urgent basis, cholecystectomy currently represents the most common abdominal operation due to the widespread use of laparoscopy and the progressively expanded indications. Compared to traditional open surgery, laparoscopic cholecystectomy minimised the duration of hospitalisation and perioperative mortality. Albeit generally considered safe, cholecystectomy may result in adverse outcomes with non-negligible morbidity. Furthermore, the incidence of worrisome haemorrhages and biliary complications has not been influenced by the technique shift. Due to the growing medico-legal concerns and the vast number of cholecystectomies, radiologists are increasingly requested to investigate recently operated patients. Aiming to increase familiarity with post-cholecystectomy cross-sectional imaging, this paper provides a brief overview of indications and surgical techniques and illustrates the expected early postoperative imaging findings. Afterwards, most iatrogenic complications following open, converted, laparoscopic and laparo-endoscopic rendezvous cholecystectomy are reviewed with examples, including infections, haematoma and active bleeding, residual choledocholithiasis, pancreatitis, biliary obstruction and leakage. Multidetector computed tomography (CT) represents the “workhorse” modality to rapidly investigate the postoperative abdomen in order to provide a reliable basis for an appropriate choice between conservative, interventional or surgical treatment. Emphasis is placed on the role of early magnetic resonance cholangiopancreatography (MRCP) and additional gadoxetic acid-enhanced MRCP to provide a non-invasive anatomic and functional assessment of the operated biliary tract.Teaching Points• Having minimised perioperative mortality and hospital stay, laparoscopy has now become the first-line approach to performing cholecystectomy, even in patients with acute cholecystitis.• Laparoscopic, laparo-endoscopic rendezvous, converted and open cholecystectomy remain associated with non-negligible morbidity, including surgical site infections, haemorrhage, residual lithiasis, pancreatitis, biliary obstruction and leakage.• Contrast-enhanced multidetector computed tomography (CT) is increasingly requested early after cholecystectomy and represents the “workhorse” modality that rapidly provides a comprehensive assessment of the operated biliary tract and abdomen.• Magnetic resonance cholangiopancreatography (MRCP) is the best modality to provide anatomic visualisation of the operated biliary tract and is indicated when biliary complications are suspected.• Additional gadoxetic acid (Gd-EOB-DTPA)-enhanced MRCP non-invasively provides functional biliary assessment, in order to confirm and visualise bile leakage.

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