Lesões iatrogênicas das vias biliares: como prevenir?

Crema, Eduardo

doi:10.1590/s0102-67202010000400001

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…Among various existing classifications for injury to the bile duct stands out Bismuth´s one (1982) 7 , 12 , more used in late stenosis mainly as consequence to thermal injury or bile duct ligature commonly associated with local/regional inflammatory reaction. The bad medical records and late re-intervention difficult classification in this case series 5 , 18 .…”

Section: Discussionmentioning

confidence: 76%

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Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy

Fortunato¹,

Gentile²,

Caetano³

et al. 2014

ABCD, arq. bras. cir. dig.

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BackgroundIatrogenic injury to the bile ducts is the most feared complication of cholecystectomy and several are the possibilities to occur.AimTo compare the cases of iatrogenic lesions of the biliary tract occurring in conventional and laparoscopic cholecystectomy, assessing the likely causal factors, complications and postoperative follow-up.MethodsRetrospective cohort study with analysis of records of patients undergoing conventional and laparoscopic cholecystectomy. All the patients were analyzed in two years. The only criterion for inclusion was to be operative bile duct injury, regardless of location or time of diagnosis. There were no exclusion criteria. Epidemiological data of patients, time of diagnosis of the lesion and its location were analyzed.ResultsTotal of 515 patients with gallstones was operated, 320 (62.1 %) by laparotomy cholecystectomy and 195 by laparoscopic approach. The age of patients with bile duct injury ranged from 29-70 years. Among those who underwent laparotomy cholecystectomy, four cases were diagnosed (1.25 %) with lesions, corresponding to 0.77 % of the total patients. No patient had iatrogenic interventions with laparoscopic surgery.ConclusionLaparoscopic cholecystectomy compared to laparotomy, had a lower rate of bile duct injury.

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Section: Discussionmentioning

confidence: 76%

“…The management of patients with these lesions is very complex, requiring experienced surgeons and mostly specialized services for the treatment of this complication. The prognosis is closely related to clinical conditions and the time between the identification of the lesion and surgical treatment 5 , 6 , 12 .…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy

Fortunato¹,

Gentile²,

Caetano³

et al. 2014

ABCD, arq. bras. cir. dig.

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“…The incidence of biliary lesion occurs in about one in every 800 procedures. [6][7][8][9][10][11][12][13][14] After the introduction of the laparoscopic surgery, indicated as the gold standard in the treatment of cholecystopathy, the incidence increased to one in every 120 procedures because of the learning curve The management of a patient with iatrogenic lesion of the biliary duct is fairly complex, requiring experienced surgeons and, mostly, specialized services. The prognosis is closely linked to the patient's clinical conditions and the elapsed time between lesion identification and institution of the appropriate surgical treatment.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of iatrogenic lesion of bile ducts in conventional and videolaparoscopic cholecystectomies

Fortunato¹,

Caetano²,

Aurélio³

et al. 2014

Revista Médica De Minas Gerais

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Objectives: to comparatively study cases of iatrogenic lesions of bile ducts that occur during in conventional and videolaparoscopic cholecystectomies carried out in the General Surgery Service and Gastro-surgery at the Ipiranga Hospital UGA-II, evaluating their likely causal factors, complications, and postoperative follow-up. Method: this was a retrospective cohort study comparatively analyzing biliary lesions arising from the surgical procedure by the analysis of medical records of patients undergoing conventional (CC) and videolaparoscopic (CC-VLP) cholecystectomies within the period of two years (from 01/01/2010 to 12/31/2011).

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“…Nos Estados Unidos, cerca de 750.000 colecistectomias são realizadas por ano 3 . Muitas vezes a ocorrência das lesões se dá pela inexperiência técnica inicial dos cirurgiões, normalmente acontecendo nos 100 primeiros procedimentos realizados 4,5,6,7 .…”

Section: Introductionunclassified

“…É m u i t o i m p o r t a n t e a v a l i a r o g r a u d e comprometimento hepático e da via biliar no momento da reconstrução, além da técnica utilizada na reconstrução do trânsito biliar, pois esses aspectos tem grande valor prognóstico. Lesões mais altas na anatomia da árvore biliar têm um grande impacto negativo no estado funcional do fígado e na sobrevida dos pacientes 4,8 . A gravidade da LIVB se dá pelo grande espectro de complicações que podem ser causadas e o quadro clínico pode cursar com icterícia, prurido, colangites de repetição e até cirrose biliar secundária, falência hepática e morte 1,6 .…”

Section: Introductionunclassified

Lesões iatrogênicas das vias biliares: diagnóstico e manejo

Neto

Perez

Lopes

2023

Rev. Med. (São Paulo)

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A lesão iatrogênica das vias biliares (LIVB) se configura em uma grave complicação relacionada a abordagens cirúrgicas do trato gastrointestinal e mesmo em centros de referência taxas de 0,2% a 1,5% ainda são registradas. A taxa de LIVB varia se a cirurgia inicial foi realizada por meio de técnica aberta ou videolaparoscópica, e a sua gravidade se dá pelo grande espectro de complicações que podem ser causadas e que apresentam forte impacto negativo na qualidade de vida do paciente. A primeira classificação de LIVB se deu em 1982 com Bismuth e, com o advento da videolaparoscopia, várias outras foram feitas, sendo a de Strasberg uma das mais utilizadas até hoje. A suspeição diagnóstica pode ser feita com auxílio de exames laboratoriais e principalmente com exames de imagem, como a colangiorressonância. O tratamento se constitui em um verdadeiro desafio para a equipe cirúrgica e pode ser realizado por meio de técnicas percutâneas endoscópicas e também cirúrgicas, sendo mais comumente realizada por meio de hepaticojejunostomia em Y de Roux. No paciente com doença hepática em estágio terminal por cirrose biliar secundária, pode ser realizado o transplante hepático. O paciente sempre que possível deve ser acompanhado por uma equipe multidisciplinar e é de suma importância que seja rapidamente encaminhado para um centro especializado.

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Lesões iatrogênicas das vias biliares: como prevenir?

Cited by 3 publications

References 8 publications

Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy

Comparative analysis of iatrogenic injury of biliary tract in laparotomic and laparoscopic cholecystectomy

Comparative analysis of iatrogenic lesion of bile ducts in conventional and videolaparoscopic cholecystectomies

Lesões iatrogênicas das vias biliares: diagnóstico e manejo

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