Síndrome de Mirizzi, complicación inusual de la colelitiasis / Mirizzi Syndrome, a Rare Complication of Cholelithiasis

Introducción: El síndrome de Mirizzi es una entidad clínica rara y difícil de tratar; sin embargo, los avances tecnológicos recientes han brindado a los cirujanos nuevas opciones para un diagnóstico y tratamiento más efectivos de esta afección. Objetivo: Presentar el caso de síndrome de Mirizzi, complicación inusual de la colelitiasis. Presentación del caso: Se presenta una paciente femenina, de 56 años de edad, que acude a nuestra institución por presentar ictericia intermitente, dolor en el hipocondrio derecho, coluria y acolia. Conclusiones: El síndrome de Mirizzi, complicación de la colelitiasis, es una entidad poco frecuente, de difícil diagnóstico preoperatorio, por lo que en un gran porcentaje de los casos se diagnostica intraoperatoriamente. Su tratamiento es quirúrgico(AU)

Introduction: Mirizzi syndrome is a rare condition, difficult to treat; however, recent technological advances have provided surgeons with new options for diagnosing and treating this condition more effectively. Objective: To present a case of Mirizzi syndrome, an unusual complication of cholelithiasis. Case presentation: The case is presented of a 56-year-old female patient, who comes to our institution with intermittent jaundice, right hypochondrium pain, choluria and acholia. Conclusions: Mirizzi syndrome, a complication of cholelithiasis, is a rare entity, difficult to diagnose preoperatively; therefore, a large percentage of it's cases are diagnosed intraoperatively. Its treatment is surgical(AU)

Factores de riesgo prequirúrgicos para una colecistectomía laparoscópica difícil / Preoperative risk factors for difficult laparoscopic cholecystectomy

RESUMEN Antecedentes: varios estudios observacionales han identificado factores de riesgo (FR) para una colecistectomía laparoscópica difícil (CLD). Objetivo: identificar los FR preoperatorios para CLD en un hospital público de mediana complejidad. Material y métodos: estudio prospectivo de cohorte transversal. Se analizaron 80 pacientes mayores de 18 años sometidos a colecistectomía laparoscópica, entre enero y diciembre de 2019. Se analizaron las variables: edad, sexo, IMC (índice de masa corporal), litiasis vesicular, pancreatitis aguda, colecistitis aguda o crónica, síndrome de Mirizzi, CPRE dentro del mes, numero de cólicos en el último mes, si presentó al menos un cólico en la última semana, leucocitos, enzimas hepáticas mayores, bilirrubina total, hallazgos de ecografía prequirúrgicos, antecedentes de cirugías abdominales previas. Resultados: la incidencia de CLD fue de 47,5%. La tasa de conversión a cirugía convencional fue del 11,25%, el 100% fueron CLD. Los FR para CLD incluyeron sexo masculino (OR: 4,50, IC 95%:1,60-12,62, p: 0,004), cólico en la semana previa a la cirugía (OR:7,17, IC 95%:1,89-27,23, p: 0,004), paredes engrosadas de la vesícula (OR: 4.90, IC 95%:1,90-12,70, p: 0,001), edema perivesicular (OR: 7,14 IC 95%:1,45-35,13 p: 0,016), la vesícula hidrópica (OR: 4,94, IC 95%:1,44-16,88, p: 0,011) y las cirugías previas (OR: 4.38 IC 95%:1,27-15,10 p: 0,001). En el análisis multivariado vemos que los pacientes de sexo masculino y pacientes con cirugías previas presentaban un riesgo elevado para CLD (OR: 6,63 IC 95%:1,75-25,08 p: 0.005; OR: 11.70 IC 95%:1,48-92,37 p: 0,020). Conclusión: se deben centrar los esfuerzos en identificar los pacientes con sospecha de CLD, pudiendo planificar la cirugía y un equipo quirúrgico experimentado.

ABSTRACT Background: The risk factors (RF) for difficult laparoscopic cholecystectomy (DLC) have been identified in many observational studies. Objective: The aim of this study is to identify the preoperative RF for DLC in a secondary care public hospital. Material and methods: We conducted a prospective cross-sectional cohort study of patients > 18 years undergoing laparoscopic cholecystectomy between January and December 2019. The following variables were analyzed: age, sex, body mass index (BMI), cholelithiasis, acute pancreatitis, acute or chronic cholecystitis, Mirizzi syndrome, ERCP within the previous month, episodes of biliary colic in the last month, presence of at least one colic within one week before surgery, white blood cell count, liver enzymes, total bilirubin, preoperative ultrasound and history of upper abdomen surgery. Results: The rate of DLC was 47.5%. Conversion rate to conventional surgery was 11.25% and 100% were categorized as DLC. The RF for DLC included male sex (OR, 4.50; 95% CI,1.60-12.62; p = 0.004), colic within 1 week before surgery (OR, 7.17; 95% CI,1.89-27.23; p = 0.004), gallbladder wall thickening (OR, 4.90; 95% CI,1.90-12.70; p = 0.001), edema around the gallbladder (OR, 7.14; 95% CI, 1.45-35.13; p = 0.016), hidrops gallbladder (OR, 4.94; 95% CI,1.44-16.88; p = 0.011) and previous surgeries (OR, 4.38; 95% CI, 1.27-15.10; p = 0.001). On multivariate analysis, male sex and previous surgery were associated with higher risk of DLC (OR, 6.63; 95% CI,1.75-25.08; p = 0.005; and OR, 11.70, 95% CI,1.48-92.37; p = 0.020, respectively). Conclusion: Efforts should focus on identifying patients with suspicion of DLC to plan surgery with an experienced surgical team.

Síndrome de Mirizzi tipo V: Manejo laparoscópico / Mirizzi syndrome type V: laparoscopic management

Resumen Introducción: El Síndrome de Mirizzi es una complicación infrecuente de la enfermedad litiásica biliar, con una incidencia menor al 1% en países desarrollados, puede desarrollarse en cinco variantes, siendo menos frecuente la variante tipo V. La literatura actual discrepa sobre el manejo de esta condición, afirmando que la cirugía laparoscópica no es segura como procedimiento estándar. Caso Clínico: Se presenta el caso de Síndrome de Mirizzi en un hombre de 80 años, que es remitido al departamento de urgencias por sospecha de sepsis de origen abdominal, con estudio ecográfico de colelitiasis, neumobilia y dilatación de las vías biliares. Se realizó Colangiopancreatografía retrógrada endoscópica con imposibilidad técnica para la movilización y extracción de los cálculos por gran tamaño, recurriéndose a exploración a través de técnica laparoscópica, obteniéndose resultados satisfactorios. Conclusión: Para tratar el Síndrome de Mirizzi, es necesario considerar las características del paciente y la experiencia del cirujano ya que ambos factores influyen directamente en la modalidad del tratamiento, sus complicaciones y tasas de éxito. En el presente caso, la experiencia del autor principal en el manejo de procedimientos mínimamente invasivos y la consideración de reducir el riesgo de complicaciones como infecciones en un paciente frágil, fueron los factores que influyeron para la decisión de intervención laparoscópica.

Abstract Introduction: Mirizzi's syndrome is an infrequent complication of biliary lithiasic disease, with an incidence of less than 1% in developed countries, being even less frequent the type V variant. Current literature disagrees on the management of this condition, stating that laparoscopic surgery is not safe as a standard procedure. Clinical Case: We present the case of Mirizzi's Syndrome in an 80-year-old man, which is referred to the emergency department for suspicion of sepsis of abdominal origin, with ultrasound study of cholelithiasis, pneumoobilia and dilation of the bile ducts. Retrograde endoscopic cholangiopancreatography was performed with technical impossibility for the mobilization and extraction of large-size stones, resorting to exploration through laparoscopic technique, obtaining satisfactory results. Conclusion: It is necessary to emphasize that the type of Mirizzi syndrome, the patient's characteristics and the surgeon's experience directly influence the treatment modality, its complications and/or success rates. In the present case, the experience of the main author in the management of minimally invasive procedures and the consideration of reducing the risk of complications such as infections in a fragile patient, were the factors that influenced the decision for laparoscopic intervention.

Síndrome de Mirizzi que simulaba una neoplasia biliar maligna / Mirizzi syndrome simulating a biliary malignant neoplasm

El síndrome de Mirizzi puede cursar con manifestaciones clínicas y hallazgos imagenológicos y de laboratorio, similares a los encontrados en las neoplasias biliares malignas. Se describe el caso de un paciente cuyo enfoque clínico inicial y estudios de imágenes aportaron datos sugerentes de neoplasia de las vías biliares. Los marcadores tumorales (CA 19-9, CEA) resultaron elevados. Una nueva evaluación clínica, la laparoscopia exploradora y la exploración endoscópica de las vías biliares, permitieron establecer el diagnóstico de síndrome de Mirizzi. Después de la extracción del cálculo biliar y de la anastomosis entre el conducto hepático y el yeyuno, el paciente permaneció asintomático. En este caso, la reevaluación clínica y el uso del protocolo adecuado de estudio, contribuyeron a orientar y confirmar el diagnóstico de síndrome de Mirizzi, lo cual determinó la conducta terapéutica más acertada

Mirizzi syndrome can occur with clinical manifestations and imaging and laboratory findings, similar to those found in malignant biliary neoplasms. We describe the case of a patient whose initial clinical approach and imaging studies provided data suggestive of bile duct neoplasia. Tumor markers (CA 19-9, CEA) were high. A new clinical evaluation, an explorative laparoscopy and endoscopic bile duct exploration allowed establish the diagnosis of Mirizzi syndrome. After removal the bile duct stone and to perform an hepatico jejunostomy the patient remained asymptomatic. In this case the clinical reevaluation and the use of the appropriate study proto-col contributed to guide and confirm the diagnosis of Mirizzi syndrome, which determined the most successful therapeutic approach

Manejo mini-invasivo de la litiasis coledociana / MINIMALLY INVASIVE SURGERY OF CHOLEDOCHOLITHIASIS

Choledocholithiasis is one of the more common benign disorders of the biliary tract with multiple features of presentation and several alternatives for its diagnosis and treatment. Our aim was to perform a based-evidence revision to propose a diagnostic and therapeutic algorithm. The raised values of gamma glutamiltranspeptidase, alkaline phosphatase and total bilirubin, are well predictors for a choledocholithiasis. The image evidence for a pre-operative detection with higher sensibility, specificity and better cost-effectiveness is the cholangioresonance. For its intraoperative detection, the cholangiography is the method most frequently used, though cholangioscopy is likewise useful. In the case of a post-operative suspicious, the cholangiography through the T tube is the gold standard. With regard to the treatment of the choledocholithiasis, the different stages are analyzed. depending if the detection was performed pre, intra or postoperatively. As a conclusion, the approach of the choledocholithiasis in one step seems to be better that to perform it in two steps, being the laparoscopic exploration for bile ducts stones more safety than the use of the intraoperative ERCP (endoscopic retrograde cholangiopancreatography) .The postoperative ERCP is not recommended excepting in very selected cases, and the biliodigestive derivations should be reserved only for the primary lithiasis of the common bile duc

Síndrome de Mirizzi tipo V, entidad infrecuente y compleja / Mirizzi's syndrome type V, a rare and complex entity

El síndrome de Mirizzi es una inflamación poco frecuente y crónica ocasionada por un cálculo impactado en la bolsa de Hartmann con obstrucción parcial o completa del conducto biliar principal, que infiere un difícil diagnóstico preoperatorio y controversial manejo terapéutico. El objetivo del trabajo fue exponer el tratamiento de cinco pacientes con diagnóstico de síndrome de Mirizzi tipo V. Se realizó una revisión de las bases de datos Pubmed, Dynamed y Conchrane en busca de artículos relacionados. Se presentó el tratamiento de esta entidad en cinco pacientes teniendo en cuenta la experiencia del autor y los hallazgos de la revisión realizada. La cirugía convencional es la vía ideal de acceso para el tratamiento de esta entidad utilizando las derivaciones bilioentéricas en sus variantes. Un alto índice de sospecha se requiere para un diagnóstico preoperatorio e intraoperatorio certero, con una óptima planificación quirúrgica(AU)

Mirizzi's syndrome is a rare and chronic inflammation caused by a gallstone impacted in the Hartmann's pouch with partial or complete obstruction of the main bile duct, which results in difficult preoperative diagnosis and controversial therapeutic management. To present the treatment of five patients diagnosed with Mirizzi's syndrome type V. A search for articles was carried out in the databases Pubmed, Dynamed and Conchrane. The treatment of this entity was presented in five patients, taking into account the author´s experience of the review´s findings. Conventional surgery is the ideal access route for this entity´s treatment using bilioenteric bypass in its variants. A high index of suspicion is required for accurate preoperative and intraoperative diagnosis, with optimal surgical planning(AU)

Mirizzi syndrome grades III and IV: surgical treatment / Síndrome de Mirizzi graus III e IV: tratamento cirúrgico

ABSTRACT Objective : to evaluate the epidemiology and outcomes of surgical treatment of patients with Mirizzi Syndrome (MS) grades III and IV, the most advanced according to Csendes classification. Methods : we conducted a retrospective, cross-sectional study by reviewing records of thirteen patients with grades III and IV MS operated from December 2001 to September 2013, among the 3,691 cholecystectomies performed in the period. Results : the incidence of MS was 0.6% (23 cases) and grades III and IV amounted to 0.35% of this number. There was a predominance of type IV (12 cases). The preoperative diagnosis was possible in 53.8% of cases. The preferred approach was biliary-digestive derivation (10 cases), and "T" tube drainage with suture of the bile duct was the choice in three special occasions. Three patients had biliary fistula resolved with clinical management, and one coliperitoneum case required reoperation. In the outpatient follow-up of patients who underwent biliodigestive anastomosis (eight), 50% are asymptomatic, 25% had anastomotic stricture and 25% lost follow-up. The mean follow-up was 41.8 months. Conclusion : MS in advanced degrees has low incidence, preoperative diagnosis in only half of cases, and has the biliodigestive anastomosis as the best conduct, but not without morbidity.

RESUMO Objetivo: avaliar a epidemiologia e os resultados do tratamento cirúrgico de doentes portadores de graus III e IV, mais avançados, da Síndrome de Mirizzi (SM) de acordo com a classificação de Csendes. Métodos: estudo retrospectivo, de corte transversal através da revisão de prontuários de 13 pacientes portadores de graus III e IV da SM operados de dezembro de 2001 a setembro de 2013, entre 3691 colecistectomias realizadas neste período. Resultados: a incidência da SM foi 0,6% (23 casos) e os graus III e IV perfizeram 0,35% deste número. Houve um predomínio de tipo IV (12 casos). O diagnóstico pré-operatório foi possível em 53,8% dos casos. A conduta preferencial foi derivação biliodigestiva (10 casos) e foi optado por drenagem com tubo "T" e sutura da via biliar em três ocasiões especiais. Três pacientes apresentaram fístula biliar resolvida com conduta expectante e um caso de coleperitônio necessitou reoperação. No seguimento ambulatorial dos pacientes que realizaram a anastomose biliodigestiva (oito), 50% estão assintomáticos, 25% apresentaram estenose da anastomose e 25% perderam seguimento. O tempo médio de acompanhamento foi 41,8 meses. Conclusão: de incidência baixa e de diagnóstico pré-operatório em apenas metade dos casos, a SM em graus avançados tem na anastomose biliodigestiva sua melhor conduta, porém não isenta de morbimortalidade.

El síndrome de Mirizzi, un desafío para el cirujano / Mirizzi syndrome, a challenge for the surgeon

El síndrome de Mirizzi es una inflamación poco frecuente y crónica ocasionada por un cálculo impactado en la bolsa de Hartmann con obstrucción parcial o completa del conducto biliar principal. Es una complicación prolongada de la enfermedad litiásica biliar e infiere un diagnóstico preoperatorio difícil, así como una compleja conducción terapéutica. El objetivo de este trabajo es realizar una actualización del tema sobre el diagnóstico y tratamiento de esta entidad. Se realizó una revisión de las bases de datos Pubmed, Dynamed y Conchrane (idioma inglés y español) en busca de los artículos relacionados con el síndrome de Mirizzi. Trabajos adicionales fueron identificados mediante búsqueda manual de las referencias de artículos relevantes. Se presentó una actualización detallada acerca del diagnóstico y tratamiento de esta entidad teniendo en cuenta la experiencia del autor y los hallazgos de la revisión realizada. Para lograr un diagnóstico preoperatorio e intraoperatorio certero se requiere un alto índice de sospecha, llevando a una óptima proyección quirúrgica para tratar esta entidad(AU)

Mirizzi syndrome is a rare and chronic inflammation, caused by a calculus stuck to the Hartmann bag, with partial or complete obstruction of the main bile duct. It is a lengthened complication of lithiasic biliary disease and effects a difficult preoperative diagnosis and a therapeutic complex treatment. To perform an updating about the of subject and to present the "state of art" diagnosis and treatment for this entity. A review of PubMed, Dynamed and Conchrane data was made (in both English and Spanish), looking for articles about Mirizzi syndrome. Additional papers were identified by manual search for references of relevant articles. A detailed updating on the diagnosis and treatment of this entity was presented, taking into account the experience of the author and the findings from the review. High suspicion index is required for an accurate preoperative and intraoperative surgical diagnoses leading to an optimal approach to treat this condition(AU)

Mirizzi Syndrome Type IV: a challenging diagnosis

Mirizzi Syndrome type IV is an extremely rare condition, which is confused with the diagnosis of cholangiocarcinoma in many cases. This report describes a case of a forty-three-year old patient, who was forwarded to our department of general surgery with a high suspicion of a choledochal neoplasic lesion. During the hospitalization he was diagnosed with Mirizzi Syndrome type IV. We concisely describe the case and the literature review about this pathology

Síndrome de Mirizzi tipo IV: diagnóstico y manejo mediante colangiopancreatografía retrógrada endoscópica: reporte de caso / Mirizzi Syndrome Type IV: diagnosis and management through retrograde endoscopic cholangiopancreatography: case report

El síndrome de Mirizzi es una rara complicación de la colelitiasis, caracterizado por obstrucción mecánica del conducto hepatocolédoco por un cálculo impactado en el cístico o en el cuello vesicular. Después de un período de tiempo puede desarrollarse una fístula colecistobiliar por destrucción de la pared del colédoco. Según la clasificación de Csendes, el tipo IV es el menos frecuente. Se presentó un caso con antecedente de colelitiasis que ingresa con cuadro clínico compatible con colangitis aguda. Se realiza CPRE electiva, diagnosticándose síndrome de Mirizzi tipo IV y se coloca prótesis como puente para el tratamiento quirúrgico. Ante un paciente con esas características, la CPRE resulta un método diagnóstico y terapéutico indispensable.

The Mirizzi syndrome is a cholelithiasis rare complication, characterized by the mechanical obstruction of the hepato choledocus duct by a calculus impacted in the cystic or in the vesicular neck. We presented a case with cholelithiasis antecedents entering the hospital with a clinical picture compatible with acute cholangitis. We made an elective cholangiopancreatography finding a big protraction of the intrahepatic biliary tracts, stretch of the supraduodenal choledoc with a common cystic-vesicular neck and choledocian environment, forming a great duct of near 20 mm diameter, having inside an ovoid filling mistake which bigger diameter is 15 mm, directed to the choledocus and to the vesicle. We diagnosed a Mirizzi syndrome Type IV. In a patient with those characteristics, the cholangiopancreatography is an unavoidable diagnostic and therapeutic method.

Mirizzi: o homem e a síndrome / Mirizzi: the man and the syndrome

A síndrome de Mirizzi é uma importante complicação da doença calculosa biliar. Pablo Luís Mirizzi, de Córdoba, Argentina, descreveu uma condição hoje conhecida como síndorme de Mirizzi, em 1948. Ele dedicou sua vida à Cirurgia e aos estudantes.

Mirizzi syndrome is an important complication of gallstone disease. Pablo Luís Mirizzi, from Córdoba, Argentina, described a condition now know as the Mirizzi syndrome, in 1948. He dedicated his life to surgery and his students.

Síndrome de Mirizzi: estudo de 11 casos / Mirizzis syndrome: report of eleven cases

Objetivo: descrever série de onze pacientes com síndrome de Mirizzi, submetidos a tratamento cirúrgico, comentando os aspectos etiopatogênicos e apresentação clínica, com ênfase no diagnóstico e tratamento. Métodos: estudo retrospectivo de onze pacientes consecutivos submetidos a tratamento cirúrgico. Foram considerados para apreciação: aspectos demográfico, clínicos, laboratoriais, meios diagnósticos, achados intraoperatórios, classificação dos doentes de acordo com Csendes et al., tática cirúrgica empregada e evolução pós-operatória. Resultados: dez pacientes (91,0%) eram mulheres e um (9,0%) homem. Os seguintes sintomas foram observados: dor e icterícia em todos os pacientes, colúria em nove (81,0%), náuseas e vômitos em sete (63,0%), acolia fecal em cinco (45,0%) e tumor palpável em um (9,0%). Os exames de laboratório mostraram leucocitose igual ou superior a 15.000 /mm3 em 45,0%. A bilirrubina total variou de 3,1 a 19,0 mg/dl. A ultrassonografia feita em todos pacientes mostrou presença de colelitíase e dilatação de V.B. em 77,7% e vesícula escleroatrófica em 27,0%. A tomografia computadorizada abdominal foi realizada em 9,0% e colangiopancreatografia em 18,0%. Os casos foram classificados, segundo Csendes, em: tipo I (quatro), tipo II (dois), tipo III (três) e tipo IV (dois) pacientes. Todos foram operados por cirurgia convencional. Destes, quatro (36,0%) apresentavam colangite, sendo três (27,0%) operados na urgência e um outro evoluiu com colangite durante a investigação, sendo operado no 19 dia. Os demais foram internados e operados eletivamente. Realizou-se: colecistectomia e derivação biliodigestiva em seis pacientes (54,0%), colecistectomia e coledocotomia em três (27,0%) e colecistectomia simples em dois casos (18%). No pós-operatório, nove (82,0%) evoluíram bem e tiveram alta hospitalar. Dois pacientes (18,0%) foram a óbito. Conclusões: todos os pacientes apresentavam sinais e sintomas de icterícia obstrutiva e em quase metade o hemograma era infeccioso. Apenas em três casos houve suspeita diagnóstica no pré-operatório. Os pacientes estáveis, sem infecção, que permitiram melhor investigação evoluíram favoravelmente. O tratamento da síndrome de Mirizzi é cirúrgico, variando a tática de acordo com o tipo da lesão.

Objectives: to report a series of eleven patients with Mirizzis syndrome submitted to surgical treatment. The authors present the etiopathogenic and clinical aspects of the disease. Methods: retrospective study of the eleven patients consecutive submitted to surgical treatment. The authors analysed the demografic, clinical and laboratory data, as well as intraoperative findings. They also classified the lesion according to Csendes classification, and presented the surgical management and post-operative follow-up. Results: there were 10 female patients (91.0 %) and 1 male patient (9.0%). Symptoms and signs were diffuse upper abdominal pain and jaundice in all patients, choluria in 9 (81%), nausea and vomit in 7 (63%), fecal acholia in 5 (45.0%) and a palpable tumor in 1 patient (9.0%). The laboratory exams showed leucocytosis equal or superior to 15.000/mm³ (45%) and the plasma bilirrubin varied between 3.1 mg/dL and 19.0 mg/dL. Ultrasonography showed in all patients the presence of cholelithiasis. There was dilation of gallbladder in 77.5% of the cases and scleroatrophic gallbladder in 27.0% patients. CT scan was realized in 9.0% and cholangiopancreatography in 18% of patients. The cases were classified according to Csendes classification. There were four type I, two type II, three type III and two type IV. All eleven cases were managed by classical open technique. Four patients (36%) presented with cholangitis; three of these patients had emergency operations and one presented cholangitis during the workup investigation, being operated on day 19 of admission. The others had elective operations. The surgical operations were: cholecystectomy and biliodigestive deviation in 6 patients (54%), cholecystectomy and choledochotomy in 3 patients (27%) and only cholecystectomy in 2 patients (18%). The postoperative course was uneventful in 9 patients (82%), but 2 patients (18%) died. Conclusion: all patients presented symptoms and signs of obstructive jaundice, and nearly half of these had infectious hemogram. The diagnosis of Mirizzis syndrome was suspected in only three patients. A complete diagnostic investigation was possible only in stable patients without infection, and these patients had a favorable course. Treatment of Mirizzis syndrome is surgical and the choice of operative approach varies according to the type of lesion.

Correlación entre el protocolo preoperatorio y los hallazgos quirúrgicos en pacientes programados para colecistectomía por colelitiasis: estudio realizado en el hospital Luis Vernaza, de la ciudad de Guayaquil en el período entre mayo de 2005 a enero de 2006 / Correlation between preoperative protocol and surgical findings in patients programmed for cholecistectomy due to cholelithiasis: study carried out in the Luis Vernaza hospital, in Guayaquil from may/2005 to january/2006

Tipo de estudio: prospectivo y descriptivo con 82 pacientes elegidos al azar, período: mayo, 2005- enero, 2006. Objetivo: Comprobar la sensibilidad y especificidad del protocolo preoperatorio utilizado en pacientes sometidos a colecistectomía por colelitiasis. Criterios de inclusión: diagnóstico único colelitiasis con protocolo preoperatorio completo programadas para colecistectomía. Criterios de exclusión: colecistectomía previa, colelitiasis con otras alteraciones de vías biliares, pacientes sin diagnóstico de colelitiasis. Protocolo preoperatorio: historia clínica, enzimas hepáticas y ecografía. Resultados: 14.6 ictericia, 12.2 coluria y 2.4 acolia; paredes vesiculares finas (65.8), gruesas (30.5) y escleroatróficas (3.6); valores anormales de bilirrubina 20.6, GOT 31.6, GPT 39, FA 34.1 y GT 50; hallazgos quirúrgicos: paredes vesiculares finas, 57.3, gruesas 37.8 y escleroatróficas, 4.8; 29.26 presentaron PAC; Pacientes con PAC, el 38 tuvo manifestaciones clínicas y DUC, 9. Pacientes con manifestaciones clínicas detectamos PAC en 64, y sin manifestaciones 22 (p=0.00157). Pacientes con PAC alterada γ GT 66.7. Valores enzimáticos significativamente superiores en PAC. Ecografía: precisión 70 al observar pared vesicular y 81-82 al determinar tamaño y cantidad de cálculos.

Study type: prospective and descriptive with 82 patients randomly selected from May/2005 to January/2006. Objective: To verify the sensitivity and specificity of the preoperative protocol used in patients who has had a cholecistectomy due to cholelithiasis. Criteria to be included: Single diagnosis: cholelithiasis with preoperative protocol and programmed for cholecistectomy. Criteria to be excluded: Prior cholecistectomy, cholelithiasis with other abnormalities of the bile ducts, patients without a diagnosis of cholelithiasis. Preoperative protocol: medical record, hepatic enzymes, and echography. Results: 14.6 jaundice, 12.2 choluria, and 2.4 acholia; gallbladder walls: thin (65.8), thick (30.5), and scleroatrophic (3.6); abnormal levels: bilirubin, 20.6; GOT, 31.6; GPT, 39; AP, 34.1 y γGT, 50; surgical findings: gallbladder walls: thin 57.3, thick 37.8, and scleroatrophic 4.8; 29.26 presented PAC; Patients with PAC: 38 had clinical symptoms and DUC, 9. Patients with clinical symptoms: in 64 PAC was found and without symptoms 22 (p=0.00157). Patients with PAC, abnormal γGT: 66.7. Enzimes levels significantly higher in PAC. Echography: accuracy 70 watching the gallblader wall, and 81-82 setting size and amount of gallstones.