¿Está exenta de consecuencias adversas la perforación iatrogénica de la vesícula biliar durante la colecistectomía laparoscópica electiva? / Iatrogenic gallbladder perforation during elective laparoscopic cholecystectomy, is it exempt from adverse consequences?

Resumen Objetivo: Este estudio se llevó a cabo para valorar las consecuencias de la perforación iatrogénica de la vesícula biliar (PIVB), investigando su asociación con complicaciones posoperatorias, uso de antibióticos y drenajes, duración de la cirugía y estancia posoperatoria. Materiales y Método: Se incluyeron 1.703 pacientes con colecistectomía laparoscópica electiva, divididos en dos grupos: con PIVB (Grupo 1; n = 321) y sin PIVB (Grupo 2; n = 1.382). Se compararon los resultados entre ambos grupos. Resultados: El porcentaje de PIVB fue de 18,85%. El vertido aislado de bilis ocurrió en 241 pacientes (14,15%) y el de bilis y cálculos en 80 pacientes (4,64%). La incidencia de infección del sitio quirúrgico no fue diferente entre ambos grupos. La incidencia de PIVB fue mayor en varones (43,3% vs 31,3%), pacientes con adherencias perivesiculares (17,75% vs. 10,5%) y pacientes con diagnóstico histológico de colecistitis aguda (11,52% vs. 4,92%). La PIVB se asoció significativamente con mayor duración de la cirugía (77,3 vs. 65,4 minutos), mayor uso de drenajes y antibióticos y mayor estancia posoperatoria. No hubo complicaciones tardías. Discusión y Conclusión: La PIVB no aumenta la incidencia de infección, pero se asocia con un mayor uso de drenajes y antibióticos, mayor duración de la cirugía y mayor estancia posoperatoria.

Aim: This study was conducted to evaluate the outcomes in patients with iatrogenic gallbladder perforation (IGP), investigating its association with postoperative complications, use of antibiotics and drains, operative time and postoperative stay. Materials and Method: 1703 patients who underwent elective laparoscopic cholecystectomy were included and divided in two groups: with IGP (Group 1, n = 321) and without IGP (Group 2, n = 1382). We compared the outcomes between both groups. Results: The IGP rate was 18.85%. Isolated bile spillage occurred in 241 patients (14.15%), and stone spillage in 80 patients (4.64%). The incidence of surgical site infections was not different between both groups. The IGP rate was significantly higher in male (43.3% vs 31.3%), in patients with perivesicular adhesions (17.75% vs 10.5%) and in patients with histologic diagnosis of acute cholecystitis (11.52% vs 4.92%). Operative time was significantly longer in patients with IGP (77.3 vs 65.4 minutes). Intraoperative drain and antibiotic use, as well as postoperative stay were, also, significantly higher in patients with IGP. There was not any late complication. Conclusión: Bile and gallstones spillage do not lead to an increase in surgical site infections, but is associated with an increased use of antibiotics and drains, longer operative time and longer postoperative stay.

Evolución de los niveles séricos de proteína C-reactiva y procalcitonina tras resección hepática / Evolution of C-reactive protein and procalcitonin serum levels after hepatic resection

Resumen Objetivo: Evaluar la evolución de los niveles séricos de proteína C-reactiva y procalcitonina tras resección hepática. Materiales y Método: Estudio observacional prospectivo, con pacientes con diferentes tipos de resección hepática, sin infección ni complicaciones mayores posoperatorias. Los niveles de proteína C-reactiva y procalcitonina se midieron el día anterior a la cirugía y diariamente, hasta el 7° día, o hasta el alta, lo primero que ocurriera. Resultados: Se incluyeron 42 pacientes. Los niveles de procalcitonina, a las 24 h, correlacionaban significativamente con la duración de la operación (p = 0,04). A las 48 h, los niveles de proteína C-reactiva fueron mayores en las resecciones hepáticas no lobares que en las lobares (p = 0,049). A las 24 h, los niveles de procalcitonina aumentaron más en las hepatectomías mayores que en las menores (p = 0,017). Los niveles de procalcitonina fueron significativamente menores en los pacientes con abordaje laparoscópico en los 4 primeros días. Conclusión: La resección hepática produce un aumento de los niveles séricos de proteína C-reactiva y procalcitonina, pero con menor intensidad si el abordaje es laparoscópico. Los niveles séricos de proteína C-reactiva tienden a ser mayores en las hepatectomías menos extensas, mientras que los de procalcitonina tienden a ser mayores en las más extensas.

Aim: To evaluate the postoperative evolution of C-reactive protein and procalcitonin after hepatic resection. Materials and Method: Prospective observational study, including patients with different types of hepatic resection, without infectious or major postoperative complications. Procalcitonin and C-reactive protein serum levels were measured on the day prior to surgery and every day after surgery until the seventh postoperative day. Results: Forty-two patients were included. There was a significant correlation between procalcitonin levels at 24 hours after surgery and the overall length of surgery (p = 0.04). C-reactive protein was higher in nonlobar hepatectomies than in lobar hepatectomies 48 hours after surgery (p = 0.049). Procalcitonin was higher in major hepatectomies than in minor hepatectomies 24 hours after surgery (p = 0.017). Procalcitonin levels were significantly lower in patients with laparoscopic approach in the first four postoperative days. Conclusion: Hepatic resection increases the serum levels of C-reactive protein and procalcitonin, but with less intensity if the approach is laparoscopic. C-reactive protein levels tend to be higher in less extensive hepatectomies and procalcitonin levels tend to be higher in more extensive resections.

Are reactive C protein and procalcitonin useful for early diagnosis of postoperative intraabdominal infection after pancreaticoduodenectomy for pancreatic cancer?

OBJECTIVE: To evaluate the relationship between C reactive protein and procalcitonin levels and the appearance of post-operative intraabdominal infection, in patients with pancreaticoduodenectomy due to pancreatic cancer. METHOD: A prospective observational study, including 35 patients, was made. Procalcitonin and C reactive protein were measured before surgery, as well as 24, 48 and 72 h after the surgical procedure. Patients were divided in two groups, with and without intraabdominal infection. RESULTS: Six patients (17.1%) presented post-operative intraabdominal infection. Both, procalcitonin and C reactive protein, increased in all patients after surgery, but there were no significant differences between the two groups. However, the ratio between the C reactive protein concentrations on post-operative day 3 and the concentrations on post-operative day 1 was significantly increased in the group of patients with intraabdominal infection. The predictive positive value and the predictive negative value for this ratio were 60% and 95%, respectively, for a cut-off point of 2.3. CONCLUSIONS: The ratio between C reactive protein value on post-operative day 3 and the value on post-operative day 1 is a good predictor of post-operative intraabdominal infection after pancreaticoduodenectomy.

OBJETIVO: Evaluar la relación entre los valores de proteína C reactiva y de procalcitonina y la aparición de infección intraabdominal posoperatoria en pacientes con duodenopancreatectomía por cáncer de páncreas. MÉTODO: Estudio prospectivo observacional que incluye 35 pacientes. Ambos parámetros se midieron antes de la cirugía y a las 24, 48 y 72 horas de la intervención. Los pacientes se dividieron en dos grupos: con y sin infección intraabdominal. RESULTADOS: Seis pacientes (17.1%) tuvieron infección intraabdominal. Ambos parámetros aumentaron en todos los pacientes tras la cirugía, pero no hubo diferencias significativas entre los dos grupos. Sin embargo, el cociente entre los valores de proteína C reactiva en el día 3 y los valores en el día 1 de posoperatorio era significativamente mayor en los pacientes con infección intraabdominal, con un valor predictivo positivo del 60% y un valor predictivo negativo del 95%, para un punto de corte de 2.3. CONCLUSIONES: El cociente entre las concentraciones séricas de proteína C reactiva en el tercer día y en el primer día de posoperatorio es un buen predictor de infección intraabdominal posoperatoria después de una duodenopancreatectomía.

Clinical Outcomes of Elective Laparoscopic Cholecystectomy: Retrospective Comparative Study Between Patients With and Without Xanthogranulomatous Cholecystitis.

AIM: The aim of this study was to evaluate the results of laparoscopic cholecystectomy (LC) in patients with xanthogranulomatous cholecystitis (XGC) compared with patients without XGC. METHODS: A retrospective study was performed including patients who had undergone elective LC between January 2003 and November 2017. Results of patients with XGC (25) were compared with those of patients without XGC (2181) with respect to operative time, conversion rate, drain use, postoperative complications, and postoperative stay. RESULTS: The mean operative times in patients with and without XGC were 112.8 and 66.3 minutes, respectively (P=0.001). The conversion rate was 36% in patients with XGC and 3.89% in patients without XGC (P=0.001). Drains were used in 76% of patients with XGC and in 24% of patients without XGC (P=0.001). Postoperative complication rate was 16% and 9.9% in patients with and without XGC, respectively (P=0.309). Mean postoperative stays in patients with and without XGC were 4.3 and 2.3 days, respectively (P=0.001). CONCLUSIONS: LC in patients with XGC is associated with significantly longer operative time, higher conversion rate, greater drain use, and longer postoperative stay compared with patients without XGC.