Pérez MA, Morales GM, Huerta JM, Röesch DF

Language: Spanish
References: 30
Page: 52-56
PDF size: 54.64 Kb.

ABSTRACT

Objective:To know the result of the surgical management of iatrogenic lesions of the biliary tract in a period of 25 years, from January 1, 1979 to December 31, 2003.
Setting:Third level health care hospital.
Patients and methods:The study was performed retrospectively and the following variables were analyzed: age, gender, time elapsed between the lesion and its surgical repair, type of lesion according to the classification of Bismuth, surgical technique used, and results of the treatment. Statistical analysis was based on central and relative tendency measures for comparisons.
Results:Hundred seventeen patients were included that presented a major lesion of the main biliary tract, of which 46 (39.3%) corresponded to cases of cholecystectomies performed by the surgical team of the same hospital and 71 (60.6%) were referred from other hospitals. The rate of lesions at our hospital was 0.6 for every 1,000 performed cholecystectomies. Women predominated with 71% of patients, the mean age of the group was 37.4 years. The predominating type of lesion was complete sectioning of the biliary tract in 94%, and according to the classification of Bismuth, 71% corresponded to type III and IV: 16.2% to type II, and 11.9% to type I. In 19.6% of the cases, repair during the same surgical act was feasible, in 55.5% during the first week, in 20.5% between 8 and 15 days after surgery, and in 4.2% after 16 days. In 81.2% of the cases a biliary tract shunt was performed by means of a choledochus-jejunum Roux en Y anastomosis, in 14.5% the hepatic hilum was dissected with anastomosis between the intrahepatic biliary ducts and the jejunum, in 2.5% the biliary duct was anastomosed to the duodenum, and, in 1.7%, term-terminal anastomosis of the choledochus was performed. Two interventions had to be performed in 6.8% of the patients, due to stenosis of the previous surgery, and three interventions were performed in 2.5%. Results of treatment were satisfactory in 79.8% of the patients, the patients remained asymptomatic without biochemical alterations of the liver function; cholangitis that was controlled in a short time was present in 13.1%; stenosis of the main biliary tract with hard to manage cholangitis was present in 4.3%; 2.6% of the patients developed secondary biliary cirrhosis. Three patients died (2.5% of all cases), one (0.8%) during the immediate postoperative period due to acute anemia secondary to hepatic lesion when placing the T catheter and two patients (1.7%) due to hepatic failure caused by secondary biliary cirrhosis at 2 and 3 years.
Conclusion:The results from our study are similar to those published by other hospitals from the Mexican health sector or in the foreign literature.

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