López FDA, García FA, Díaz TJ, Zamora-Valdés D, Nachón GFJ

Language: Spanish
References: 22
Page: 82-90
PDF size: 828.97 Kb.

ABSTRACT

Background: The selection of the biliodigestive bypass and a refined surgical technique are fundamental principles in the restitution of an enterohepatic circuit. In this work, we evaluate the experience in the biliodigestive bypass surgery (DBD) in our Specialized Medical Center of Veracruz (CEMEV). Methods: A review of the medical files of the patients treated in the last four years in the CEMEV. Results: A DBD was performed in 31 cases, 27 women and four men. The indications were biliary obstruction (48.39%), bile duct injury (LVB) (35.48%), Mirizzie syndrome (9.68%) and choledochal chyst (6.45%). The DBD performed were Roux-en-Y terminolateral hepaticoyeyunostomy (45.16%), laterolateral choledochoduodenostomy (19.36%), Kasai portoenterostomy (12.91%), Roux-en-Y laterolateral hepaticoyeyunostomy with partial resection of IV segment (9.68%), transduodenal sphincteroplasty (6.45%), Braun’s omega laterolateral hepaticoyeyunostomy (3.22%) and Roux-en-Y hepaticoyeyunostomy with independent anastomosis (3.22%). The greater frequency of complications were found in Kasai portoenterostomy (50%) and laterolateral choledochoduodenostomy (33.33%). The poor prognosis factors were proximal LVB, complex biliary disease, intraoperative bleeding, intra-abdominal collection, biliary fistula and sepsis. In accordance with the criteria of Lillemoe, we obtained an adequate outcome in 80.65%. Conclusions: In CEMEV, as a medical center of regional reference for complex pathologies and surgical hepatobiliary complications, it is required to develop more experience in responding to this issues, in order to meet international standards. Our experience proved that the best results were obtained with the Roux-en-Y terminolateral hepaticoyeyunostomy.

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