RESUMO
BACKGROUND: There are many different strategies for the treatment of the main bile duct lithiasis. When lithiasis of the biliary tract is suspected at a preoperative stage, we can treat patients with sequential treatment: endoscopic netrograde cholangiopancreatography followed by laparoscopic cholecystectomy. If common bile duct-lithiasis is recognized at an intraoperative stage, many options for treatment exist, one of which is intraoperative retrograde endoscopic sphincterotomy (ES) (laparoendorendezvous). METHODS: We report our experience using the aforementioned technique with 58 patients affected by cholelithiasis and complex Common bile duct disease who underwent laparoscopic cholecystectomy and intraoperative ES consecutively from March 1996 to May 2000. Of the 58 patients, 43 were affected by cholecystocholedocolithiasis: 12 by previously described lithiasis plus stenosant papillitis, 2 also by a pancreas head cancer, and 1 by cancer of the papilla. RESULTS: The combined technique was performed in 86% of the cases. Six patients required conversion to open surgery. In two other patients, laparoscopic choledocotomy was performed with positioning of a Kehr-tube for an ampulla-impacted lithiasis. CONCLUSIONS: Intraoperative ES offers a valid approach to the treatment of cholecystocholedocolithiasis in one session. Furthermore, it represents a valid alternative to transcholedocical laparoscopic treatment of cholelithiasis and complex common bite duct pathology.
Assuntos
Doenças dos Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Constrição Patológica/cirurgia , Cálculos Biliares/cirurgia , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Cateterismo/efeitos adversos , Cateterismo/instrumentação , Cateterismo/métodos , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/instrumentação , Ducto Cístico/cirurgia , Drenagem/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Esfinterotomia Endoscópica/efeitos adversos , Esfinterotomia Endoscópica/instrumentação , Esfinterotomia Endoscópica/métodosRESUMO
The authors discuss the problems of emergency treatment of cavernous hemangiomas of the liver. Five cases were observed and treated with different techniques, ligation of the hepatic artery, excision of the mass, embolization of the hepatic artery. The results of these procedures were strongly influenced by the patient's previous state. Treatment was successful in three patients, while the procedure adopted was able to stop the hemorrage in the other two patients. The physical state was very important for the prognosis; the two patients arriving at our Institute in deep shock both died.