Indications of hepatectomy for iatrogenic biliary injury [Indicaciones de hepatectomía en lesión biliar iatrógena]
Por:
Mercado M.Á., Sánchez N., Ramírez-Del Val F., Cerón R.C., Urencio J.M., Domínguez I.
Publicada:
1 ene 2010
Categoría:
Gastroenterology
Resumen:
Background: The most efficient surgical procedure to treat bile duct injuries is a Roux en Y hepatoyeyunoanastomosis (RY-HYA). A small group of patients who have undergone a RY-HTA develop cholangitis without jaundice, with proven permeability of the anastomosis. Objective: To describe our experience in this subgroup of patients. Patients and methods: 355 patients received surgical treatment for BDI with a RY-HYA. Medical charts of patients diagnosed with segmentary cholangitis involving a single hepatic lobe were reviewed. Segmentary cholangitis with intra-hepatic abscess was diagnosed through computer tomography, endoscopic retrograde cholangiopancreatography or by percutaneous transhepatic cholangiography. Results: We found 10 patients with segmentary cholangitis within the 355 cases in our series. Eight of them received treatment with a right hepatectomy and two of them with a left hepatectomy. In every patient, the hepatoyeyunoanastomosis was dismantled during the reoperation, corroborating the presence of a wide and permeable anastomosis. Surgical exploration was conducted through the hepatic ducts. After the affected lobe hepatectomy a new hepatoyeyunoanastomosis was performed. Out of the 10 patients one died (mortality 10%) due to hepatic cirrhosis. In the rest of the group a satisfactory resolution of the segmentary cholangitis was observed. Conclusions: In our series, 3% of the patients required a mayor hepatectomy for the persistent cholangitis to resolve, despite the presence of a functional bilioenteric anastomosis. Segmentary cholangitis must be suspected in patients with normal levels of direct bilirubin and abnormal liver function tests with clinical manifestations of cholangitis.
Filiaciones:
Mercado M.Á.:
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, C.P. 14000. México, D. F., Mexico
Sánchez N.:
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, C.P. 14000. México, D. F., Mexico
Ramírez-Del Val F.:
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, C.P. 14000. México, D. F., Mexico
Cerón R.C.:
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, C.P. 14000. México, D. F., Mexico
Urencio J.M.:
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, C.P. 14000. México, D. F., Mexico
Domínguez I.:
Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, C.P. 14000. México, D. F., Mexico
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