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1.
Int. j. morphol ; 38(3): 552-557, June 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1098286

RESUMO

La colecistectomía laparoscópica es el tratamiento de elección de la colelitiasis; sin embargo, se acompaña de comorbilidades y no está exenta de complicaciones mayores que pueden ser letales; la identificación del trígono cistohepático con disección y ligadura de la arteria cística son pasos obligatorios de la cirugía; la identificación de las variaciones de la arteria cística y los conductos biliares pueden minimizar las eventuales complicaciones. Al protocolo preoperatorio se implementó una angiotomografía con Tomógrafo Siemens Somatón Sensation ® de 64 cortes para identificar la arteria cística en pacientes con colelitiasis de la Unidad de Cirugía General del Hospital de Especialidades Teodoro Maldonado Carbo IESS de Guayaquil. Se escogieron 60 pacientes femeninos en forma aleatoria (edades 19-70 años, promedio 44,25 años) y la muestra se dividió en dos grupos de 30; al grupo estudio se aplicó angiotomografía hasta un mes antes de la cirugía y al grupo control se le aplicó el protocolo convencional. Se evaluó morbilidades relacionadas con: hemorragia operatoria por lesión de la arteria cística y en el posoperatorio: infección de herida operatoria, íleo y drenaje. La angiotomografía permitió identificar la arteria cística en el preoperatorio y contribuyó a disminuir comorbilidades que acompañan a la colecistectomía laparoscópica.


Laparoscopic cholecystectomy is the treatment of cholelithiasis of choice; however, it is accompanied by comorbidities and is not exempt from major complications that can be lethal; the identification of the cystohepatic trigone with dissection and ligation of the cystic artery are mandatory steps of surgery; the identification of the variations of the cystic artery and the bile ducts can minimize the possible complications. The preoperative protocol was implemented with an angiotomography with Siemens Somatón Sensation ® 64-slice Tomograph to identify the cystic artery in patients with cholelithiasis of the General Surgery Unit of the Teodoro Maldonado Carbo IESS Specialty Hospital of Guayaquil. 60 female patients were chosen at random (ages 19 -70 years, average 44.25 years) and the sample was divided into two groups of 30; Angiotomography was applied to the study group up to one month before surgery and the conventional protocol was applied to the control group. Morbidities related to: operative haemorrhage due to cystic artery and postoperative injury: operative wound infection, ileus and drainage were evaluated. Angiotomography allowed to identify the cystic artery in the preoperative period and contributed to decrease comorbidities that accompany laparoscopic cholecystectomy.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Colelitíase/cirurgia , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios , Colelitíase/diagnóstico por imagem , Comorbidade , Artéria Celíaca/anatomia & histologia , Colecistectomia Laparoscópica
2.
Univ. salud ; 22(1): 96-101, ene.-abr. 2020. graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1094585

RESUMO

Introducción: El íleo biliar se define como una obstrucción intestinal por impactación de un cálculo biliar a cualquier nivel, sucede por presencia de una fistula bilio-digestiva y es usual en personas mayores de 60 años, principalmente en mujeres. Objetivo: Describir un caso de íleo biliar en un paciente masculino adulto medio, tratado con enterolitotomia más colecistectomía. Presentación del caso: Paciente masculino de 41 años, sin antecedentes patológicos conocidos, con diagnóstico de íleo biliar, quién recibió manejo quirúrgico con enterolitotomia más colecistectomía en el mismo tiempo quirúrgico, con posteriores reintervenciones y manejo en unidad de cuidado intensivo, teniendo evolución favorable y egreso hospitalario. Conclusión: Este caso de obstrucción intestinal en paciente sin antecedentes quirúrgicos abdominales y con edad de presentación atípica para íleo biliar, representa un reto para el diagnóstico clínico y su correspondiente manejo quirúrgico.


Introduction: Biliary ileus is defined as an intestinal obstruction caused by gallstones. It is due to the presence of a bile-digestive fistula and is common in people older than 60 years of age, mainly in women. Objective: To describe a case of biliary ileus in an average adult male patient treated with enterolithotomy and cholecystectomy. Presentation of the case: A 41-year-old male patient, with a diagnosis of biliary ileus and no known pathological history, who underwent surgical management with enterolithotomy and cholecystectomy at the same surgical time. He had subsequent surgical interventions and management in an intensive care unit, having a favorable outcome and hospital discharge. Conclusion: This case of intestinal obstruction in a patient with no abdominal surgical history and an atypical age presentation represents a challenge for clinical diagnosis of biliary ileus and its corresponding surgical management.


Assuntos
Adulto Jovem , Colelitíase , Fístula Biliar , Íleus , Obstrução Intestinal
3.
Arch. med ; 20(1): 221-225, 2020-01-18.
Artigo em Espanhol | LILACS | ID: biblio-1053285

RESUMO

Las fístulas colecistoentéricas se forman como una complicación poco frecuente de la colelitiasis. Se presenta el caso de un paciente femenino de 64 años con diagnóstico de sangrado de tubo digestivo alto debido a una fístula colecistoduodenal. El caso representa una urgencia gastroenterológica poco común que nos recuerda que las complicaciones raras de las enfermedades comunes pueden ser fácilmente omitidas en cualquier escenario clínico..(AU)


Bilioenteric fístulas occurs as a rare complication of gallstone disease. A 64 years-old female patient with diagnosis of upper digestive bleeding due to a cholecystoduodenal fístula is presented. This clinical case represents a rare gastrointestinal emergency that remember us that rare complications of diverse diseases can be omitted in any clinical scenario..(AU)


Assuntos
Feminino , Colelitíase , Fístula
4.
Int. j. morphol ; 37(4): 1456-1462, Dec. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1040153

RESUMO

La colecistectomía laparoscópica es el tratamiento indicado en la colelitiasis, sin embargo el procedimiento no está exento de complicaciones o morbilidad concomitante. Es posible que, debido a lesiones ductales colaterales, ocurra sangrado con posibilidad de conversión de la cirugía e indeseables resultados. Para un correcto abordaje de la región se hace fundamental la identificación del trígono cistohepático (TCH) y sus componentes, a su vez de la ligadura y sección de la arteria cística (AC). Conociendo la elevada variabilidad de la AC, el objetivo de este trabajo consistió en identificar el número, origen, trayecto y relación de la AC con el TCH y sus variaciones, utilizando angiotomografía por medio de un tomógrafo detector de 64 cortes, en el preoperatorio de 30 pacientes de sexo femenino, entre 24 y 54 años de edad, con colelitiasis diagnosticadas clínicamente y por ecosonografía. La AC en el 76,67 % era única y se encontraba dentro del TCH, en el 16,67 % era única y se observó fuera del TCH. En el 6,67 % se observaron dos AC, una dentro y otra fuera del TCH. En el 66,67 % de los casos la AC se originaba de manera normal de la arteria hepática derecha. La trazabilidad de la AC fue en el 53,3 % medianamente visible y en el 46,7 % de trazabilidad excelente. En conclusión, la identificación de la AC y sus variaciones anatómicas se puede determinar en el preoperatorio y puede ser útil para mejorar el plan quirúrgico en pacientes con colelitiasis, brindando información al procedimiento, optimizarlo y disminuir los riesgos de eventuales complicaciones relacionados con sangrado.


Laparoscopic cholecystectomy is the treatment indicated for cholelithiasis, however the procedure is not free of complications or concomitant morbidity. It is possible that, due to collateral ductal lesions, bleeding occurs with the possibility of surgery conversion and undesirable results. For a correct approach to the region it is essential to identify the cystohepatic trigone (CHT) and its components, as well as the ligation and section of the cystic artery (AC). Knowing the high variability of CA, the aim of this work was to identify the number, origin, path and relationship of CA with the CHT and its variations using angiotomography by means of a 64-slice detector tomograph in the preoperative period of 30 female patients, between 24 and 54 years old, with clinically diagnosed cholelithiasis and by echo sonography. The AC in 76.67 % was unique and was within the CHT, in 16.67 % it was unique and was observed outside the CHT. In 6.67 %, two ACs were observed, one inside and one outside the TCH. In 66.67 % of cases, CA originated normally from the right hepatic artery. The traceability of AC was 53.3 % moderately visible and 46.7 % excellent traceability. In conclusion, the identification of AC and its anatomical variations can be determined in the preoperative period and can be useful to improve the surgical plan in patients with cholelithiasis, providing information on the procedure, optimizing it and reducing the risks of possible bleeding related complications.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Artérias/anormalidades , Artérias/diagnóstico por imagem , Colecistectomia Laparoscópica/métodos , Angiografia por Tomografia Computadorizada , Cuidados Pré-Operatórios/métodos , Colelitíase/cirurgia , Variação Anatômica , Artéria Hepática/anormalidades , Artéria Hepática/diagnóstico por imagem
5.
Prensa méd. argent ; 105(1): 34-40, mar 2019. tab, graf
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1026338

RESUMO

Being the main treatment for cholelithiasis, laparoscopic cholecystectomy does not always solve the problem. It often entails postcholecystectomy syndrome (PCS). Oral medication to dissolve gallstones with bile acids is alternative therapy for some patients. However, lack of efficacy and limited medical indications make it necessary to apply combination treatment tactics. This study was conducted to investigate the dissolution of gallstones during the combined effects of ursodeoxycholic acid (UDCA) and rosuvastatin as well as to assess the results of eradication therapy in the presence of H. pylory as a measure to prevent cholelithiasis in the course of treatment.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Ácido Ursodesoxicólico/uso terapêutico , Colelitíase/prevenção & controle , Colelitíase/tratamento farmacológico , Administração Oral , Helicobacter pylori , Quimioterapia Combinada/tendências , Erradicação de Doenças , Rosuvastatina Cálcica/uso terapêutico
6.
Rev. Col. Bras. Cir ; 46(6): e20192279, 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-1057182

RESUMO

RESUMO Objetivo: descrever os achados histológicos das vesículas biliares de pacientes submetidos à colecistectomia e avaliar a presença de fatores associados ao câncer incidental da vesícula. Métodos: estudo descritivo, transversal e observacional de 1.278 exames anatomopatológicos de vesículas biliares oriundas de colecistectomias por colelitíase e de seus respectivos laudos, realizadas no período de janeiro de 2008 a dezembro de 2017. Resultados: o achado anatomopatológico mais frequente foi a colecistite crônica, presente em 1.251 pacientes (97,8%), seguido pela colesterolose em 131 (10,2%). O câncer de vesícula foi identificado em seis pacientes, com prevalência de 0,5% nesta amostra. Houve associação significativa entre a presença de câncer e idade ≥60 anos e com a espessura da parede ≥0,3cm. Conclusão: houve baixa prevalência de câncer de vesícula na população avaliada, maior ocorrência na população idosa e associação de tumor com espessamento da parede vesicular.


ABSTRACT Objective: to describe the histological findings of the gallbladders of patients undergoing cholecystectomy and to evaluate the presence of factors associated with gallbladder incidental cancer. Methods: we conducted a descriptive, cross-sectional, observational study with 1,278 histopathological exams of gallbladders coming from cholecystectomy for cholelithiasis and of their reports, held from January 2008 to December 2017. Results: the most common pathological finding was chronic cholecystitis, present in 1,251 patients (97.8%), followed by gallbladder cholesterolosis, in 131 (10.2%). Gallbladder cancer was identified in six patients, with a prevalence of 0.5% in this sample. There was a significant association between the presence of cancer and age ≥60 years and wall thickness ≥0.3cm. Conclusion: there was low prevalence of gallbladder cancer in this population, higher occurrence in the elderly and association of the tumor with gallbladder wall thickness.


Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Colecistectomia/métodos , Colelitíase/patologia , Colecistite/patologia , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/patologia , Colelitíase/cirurgia , Colelitíase/complicações , Colecistite/cirurgia , Colecistite/complicações , Estudos Transversais , Fatores de Risco , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/etiologia , Pessoa de Meia-Idade
7.
Artigo em Inglês | LILACS, COLNAL | ID: biblio-989566

RESUMO

ABSTRACT Introduction: Bouveret syndrome is a rare form of gallstone ileus that causes gastric obstruction due to the presence of a gallstone in the pylorus or duodenum, secondary to biliodigestive fistula. This condition is difficult to diagnose and one of its main complications is hemorrhage in the digestive tract. Two-stage surgical management is recommended, although it can also be managed through upper endoscopy in gallstones smaller than 2.5cm. Prognosis and postoperative period are good. Clinical case: 63-year-old patient with a clinical picture of 15 days of pain in the epigastrium and bilious vomiting. Imaging showed a calcified mass in the second part of the duodenum, which was surgically treated by entering the jejunum, performing an enterotomy and extracting the gallstone. The patient was discharged on the fifth day without any symptoms. Conclusion: Bouveret syndrome is a rare entity that requires better medical assessment and ancillary imaging techniques to achieve a timely diagnosis.


RESUMEN Introducción. El síndrome de Bouveret es una entidad poco frecuente de íleo biliar que provoca obstrucción gástrica debido a la presencia de un lito biliar a nivel de píloro o duodeno y secundaria a una fistula biliodigestiva. Esta enfermedad es de difícil diagnóstico y una de sus complicaciones es la hemorragia digestiva alta; su manejo es quirúrgico y se recomienda en dos tiempos, aunque se puede manejar por endoscopia alta en aquellos cálculos <2.5cm. El pronóstico es bueno, con un post-operatorio sin novedades. Presentación del caso. Paciente de 63 años con cuadro clínico de 15 días de evolución de dolor en epigástrico y vómitos biliosos incontables. Se realizaron imágenes diagnósticas donde se evidenció masa calcificada en duodeno II, por lo que la paciente fue intervenida quirúrgicamente: se progresó el cálculo a yeyuno, se realizó enterotomía y se extrajo el lito. Al quinto día fue dada de alta sin novedades. Conclusión. El síndrome de Bouveret es una entidad rara que requiere de una adecuada valoración médica y de métodos auxiliares de imágenes para un diagnóstico oportuno.


Assuntos
Humanos , Colelitíase , Cálculos Biliares , Obstrução Duodenal
10.
Rev. colomb. cir ; 33(2): 154-161, 2018. tab
Artigo em Espanhol | LILACS | ID: biblio-915630

RESUMO

Objetivo. Describir los resultados clínicos y quirúrgicos de la colecistectomía por laparoscopia, en pacientes con colecistitis subaguda hospitalizados en una institución universitaria de alta complejidad. Metodología. Se llevó a cabo un estudio descriptivo y retrospectivo de pacientes adultos con diagnóstico de colecistitis subaguda, intervenidos con colecistectomía por laparoscopia, que fueron hospitalizados en una institución universitaria de alto nivel de complejidad entre enero y diciembre de 2014. Se evaluaron sus características sociodemográficas, clínicas, del procedimiento, las complicaciones operatorias y a los 30 días, así como la estancia hospitalaria. Resultados. Se analizaron 184 pacientes con un promedio de edad de 59 años (DE=19,34), el 61 % de sexo femenino. La mayoría de los pacientes (69%) tenían hallazgos intraoperatorios correspondientes a plastrón, piocolecisto, necrosis y perforación. En 13 % de los pacientes fue necesaria la conversión a cirugía abierta, y entre las complicaciones se presentó sangrado operatorio en 13 %, fístula biliar en 2,7 % y lesión de la vía biliar en 0,5 %. La mortalidad intrahospitalaria fue del 1,1 %. Concusiones. La colecistectomía laparoscópica es un procedimiento seguro con una baja tasa de complicaciones, incluso, cuando se practica en casos con más de 72 horas de iniciados los síntomas. Es indispensable que dicho procedimiento sea realizado por un grupo con gran experiencia en cirugía laparoscópica


Objective: To report the clinical results of laparoscopic cholecystectomy in patients with subacute cholecystitis hospitalized at a high complexity level of care university hospital in Medellín, Colombia.Methodology: A retrospective descriptive study was carried out in adult patients diagnosed with subacute cholecystitis who underwent laparoscopic cholecystectomy between January and December 2014. Sociodemographic, clinical, procedural characteristics, intraoperative complications at 30 days, as well as the hospital stay, were evaluated. Results: A total of 184 patients met the inclusion criteria, with a mean age of 59 years, predominantly female (61%); open surgery conversion rate was 13%, intraoperative bleeding 13%, biliary fistula 2.7%, bile duct injury 0.5%, and global mortality 1.1%. Conclusions: Laparoscopic cholecystectomy is a safe procedure with a low rate of complications, even when performed in patients with more than 72 hours of symptom onset. It is essential that this procedure be performed by a group with high experience in laparoscopic surgery


Assuntos
Humanos , Vesícula Biliar , Colecistectomia Laparoscópica , Colecistite Aguda , Colelitíase
11.
Rev. colomb. cir ; 33(2): 145-153, 2018. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-915650

RESUMO

Introducción. La colecistectomía laparoscópica es la técnica de elección en pacientes con indicación de extracción quirúrgica de la vesícula; sin embargo, en promedio, el 20 % de estos requieren conversión a técnica abierta. En este estudio se evaluaron los factores preoperatorios de riesgo para conversión en colecistectomía laparoscópica de urgencia. Metodología. Se llevó un estudio de casos y controles no pareado. Se obtuvo información sociodemográfica y de las variables de interés de los registros de las historias clínicas de los pacientes operados entre el 2013 y el 2016. Se identificaron los motivos de conversión de la técnica quirúrgica. Se caracterizó la población de estudio y se estimaron las asociaciones según la naturaleza de las variables. Mediante un análisis de regresión logística se ajustaron las posibles variables de confusión. Resultados. Se analizaron los datos de 444 pacientes (111 casos y 333 controles). La causa de conversión más frecuente fue la dificultad técnica (50,5 %). Se encontró que la mayor edad, el sexo masculino, el antecedente de cirugía abierta en hemiabdomen superior, el signo clínico de Murphy positivo, la dilatación de la vía biliar, la leucocitosis y la mayor experiencia del cirujano fueron los factores de riesgo para la conversión. Se encontró un área bajo la curva ROC de 0,743 (IC95% 0,692-0,794, p≤0,001). Discusión. Existen factores que se asocian a mayor riesgo de conversión en colecistectomía laparoscópica. La mayoría se relaciona con un proceso inflamatorio avanzado, por lo que la intervención temprana y oportuna debe ser el estándar de manejo en el abordaje de pacientes con patología quirúrgica de la vesícula


Introduction: Laparoscopic cholecystectomy is the preferred technique for patients with indication for gallbladder extraction. Nevertheless, up to near 20% of them require conversion to open surgery. In this study we evaluated preoperative risk factors for conversion in patients undergoing emergency laparoscopic cholecystectomy. Methodology: a case-control unmatched study was conducted. Sociodemographic Information and other variables were obtained from the medical records of patients that underwent surgery in the period 2013 to 2016. Reasons for conversion were identified and the study population was characterized. Correlations tests were established and logistic regression was performed for evaluating the role of confounding factors. Results: we analyzed the medical records of 444 patients (111 cases and 333 controls). The most common reasons for conversion were technical difficulty (50,5%), older age, male sex, previous open upper abdominal surgery, Murphy´s sign, bile duct dilation, total white cell count >12.000/mm3 , and a more experienced surgeon. Area under COR was 0.743 (CI95% 0.692­0.794, p= <0.001). Discussion: some factors increase the risk for conversion to open surgery in laparoscopic cholecystectomy. Most of them are related to an advanced gallbladder inflammatory process, thus early and timely intervention should be the gold standard in the management of patients with surgical gallbladder pathology


Assuntos
Humanos , Colelitíase , Colecistectomia Laparoscópica , Conversão para Cirurgia Aberta , Fatores de Risco
12.
Rev. colomb. cir ; 33(2): 162-172, 2018. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-915653

RESUMO

Introducción. Los factores de riesgo para la conversión a laparotomía y las complicaciones de la colecistectomía laparoscópica se han estudiado, pero no se conocen modelos actuales de predicción para estos resultados. Objetivo. Desarrollar un modelo de predicción para las complicaciones de la colecistectomía laparoscópica. Pacientes y métodos. Se llevó a cabo un estudio analítico retrospectivo que incluyó 1.234 pacientes con colelitiasis sometidos a colecistectomía laparoscópica, en un periodo de 18 meses en un hospital de IV nivel de Colombia. Se hizo el análisis multivariado por medio de regresión logística, usando el procedimiento backward para selección de variables, buscando determinar la probabilidad en un punto compuesto de complicación (presencia de, al menos, una complicación: lesión de vía biliar, colección intraabdominal o sangrado). Se elaboró una curva ROC para determinar la capacidad predictiva del modelo y el análisis de datos se hizo en Stata 13™. Resultados. Los pacientes incluidos se clasificaron en cohortes de derivación (926) y de validación (308), y se encontró que el 69,2 % eran mujeres; la edad mediana fue de 48 años (RIC=34-60) y, la conversión, de 4,3 %; hubo colección intraabdominal en 2,6 % y complicaciones en 4,7 %, y la mortalidad global fue de 0,3 %. La edad, la diabetes mellitus, la enfermedad renal crónica, la coledocolitiasis y el síndrome de Mirizzi se identificaron como predictores de alguna complicación. La capacidad predictiva del modelo fue de 58 %. Conclusión. La probabilidad de alguna complicación perioperatoria de la colecistectomía por laparoscopia depende de la edad, la diabetes mellitus, la enfermedad renal crónica, la coledocolitiasis y el síndrome de Mirizzi. Los factores de riesgo y las complicaciones descritos aquí, pueden guiar nuevas investigaciones y proporcionar evaluación de riesgos específicos


Introduction. Risk factors associated with conversion from laparoscopic cholecystectomy to open surgery and its complications are well known. However, there are currently no prediction models for such outcomes. The objective of tis work was to devolop a prediction model for laparoscopic cholecystectomy complications. Materials and methods. This is a retrospective analytical study that included 1,234 patients who underwent laparoscopic cholecystectomy in an 18 months period at a fourth level of care hospital in Bogota, Colombia. A multivariable logistic regression analysis using backward procedure was performed to for the selection of variables, in order to determine the likelihood of a combined endpoint complication (presence of at least one of the complications: bile ducts injury, haemorrhage, organ/space surgical site infection). A ROC curve was performed to determine the predictive ability of the model; information analysis was performed in 13 STATA. Results. Patients were classified in a derivation (926) and a validation cohort (308). It was found that 69.2 % were female, median age 48 years (IQR 34-60 ), conversion rate 4.3%, organ/space surgical site infections 2.6%, combined end point complication 4.7%, and global mortality rate 0.3%. Diabetes mellitus (DM), chronic kidney disease (CKD), choledocholitiasis and Mirizzi´s syndrome were found as predictors of the occurrence of complications. The model was validated in the validation cohort, obtaining an area under the ROC curve of 58%. Discussion. The likelihood of major complication in laparoscopic cholecystectomy depends on age, DM, CKD, choledocholitiasis, and Mirizzi´s syndrome. Risk Factors and complications described here can guide a new research avenue and provide the evaluation of specific risks


Assuntos
Humanos , Colelitíase , Colecistectomia Laparoscópica , Complicações Intraoperatórias , Medição de Risco
13.
Rev. Col. Bras. Cir ; 45(6): e1995, 2018. tab, graf
Artigo em Português | LILACS | ID: biblio-976940

RESUMO

RESUMO Objetivo: identificar fatores de risco para a ocorrência de complicações pós-operatórias em colecistectomias videolaparoscópicas (CVL) em pacientes idosos. Métodos: estudo observacional com análise de prontuários médicos de pacientes com idade igual ou superior a 60 anos, submetidos à colecistectomia videolaparoscópica eletiva no Hospital Universitário Gaffrée e Guinle, entre os anos de 2006 e 2018. Cirurgias realizadas em regime de emergência ou convertidas para a técnica convencional foram excluídas do estudo. Resultados: foram incluídos no estudo 345 pacientes, sendo 80% do sexo feminino e 62% com idade entre 60 e 69 anos. Houve 39 casos de complicações pós-operatórias (11,3%), em sua maioria (87%) classificadas como tipo I ou II da escala de complicações cirúrgicas de Clavien-Dindo. Houve somente um caso de óbito. Presença e quantidade de doenças coexistentes e classificação de estado físico ASA II ou III conferiram risco maior para o desenvolvimento de complicações e mortalidade pós-operatórias. Conclusão: o estudo identificou a presença de doenças coexistentes e a gravidade das mesmas, segundo a classificação ASA, como fatores de risco para o desenvolvimento de complicações no pós-operatório de colecistectomias videolaparoscópicas em pacientes idosos. Entretanto, a CVL se mostrou uma técnica segura quando empregada nestes pacientes com taxas de morbimortalidade baixas.


ABSTRACT Objective: to identify risk factors for the occurrence of postoperative complications in laparoscopic cholecystectomies (LC) in elderly patients. Methods: an observational study with analysis of medical records of patients aged 60 years and older, submitted to elective LC at Gaffree e Guinle Universitary Hospital, from 2006 to 2018. Surgeries performed on an emergency basis or converted to the conventional technique were excluded from our study. Results: a total of 345 patients were included in our study, being 80% females and 62% aged 60-69 years. There were 39 cases of postoperative complications (11.3%), mostly (87%) classified as grades I or II of Clavien-Dindo surgical complication scale. There was only one death. The presence and the number of coexisting diseases and ASA II or III physical status classification of preoperative patients conferred a greater risk for the development of postoperative complications and mortality. Conclusion: our study identified the presence of coexisting diseases, as well as their severity, according to ASA classification, as risk factors for the development of postoperative complications of LC in elderly patients. However, LC proved to be a safe technique when used in these patients with low morbidity and mortality rates.


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/epidemiologia , Colelitíase/cirurgia , Colecistectomia Laparoscópica/estatística & dados numéricos , Índice de Gravidade de Doença , Brasil/epidemiologia , Cálculos Biliares/cirurgia , Comorbidade , Fatores de Risco , Hospitais Universitários , Pessoa de Meia-Idade
14.
Acta cir. bras ; 32(12): 995-1005, Dec. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-886196

RESUMO

Abstract Purpose: To evaluate the actual incidence of both microlithiasis and acute cholecystitis during treatment with intravenous ceftriaxone in a new rabbit model. Methods: New Zealand rabbits were treated with intravenous ceftriaxone or saline for 21 days. Ultrasound monitoring of the gallbladder was performed every seven days until the 21st day when histopathology, immunohistochemistry for proliferating cell nuclear antigen (PCNA), pro-caspase-3 and CD68, liver enzyme biochemistry, and chromatography analysis of the bile and sediments were also performed. Results: All animals treated with ceftriaxone developed acute cholecystitis, confirmed by histopathology (P<0.05) and biliary microlithiasis, except one that exhibited sediment precipitation. In the group treated with ceftriaxone there was an increase in pro-caspase-3, gamma-glutamyl transpeptidase concentration, PCNA expression and in the number of cells positive for anti-CD68 (P<0.05). In the ceftriaxone group, the cholesterol and lecithin concentrations increased in the bile and a high concentration of ceftriaxone was found in the microlithiasis. Conclusion: Ceftriaxone administered intravenously at therapeutic doses causes a high predisposition for lithogenic bile formation and the development of acute lithiasic cholecystitis.


Assuntos
Animais , Ratos , Ceftriaxona/efeitos adversos , Colecistectomia , Colelitíase/induzido quimicamente , Colecistite Aguda/induzido quimicamente , Antibacterianos/efeitos adversos , Ceftriaxona/administração & dosagem , Colelitíase/metabolismo , Colecistectomia Laparoscópica , Colecistite Aguda/metabolismo , Modelos Animais de Doenças , Pesquisa Médica Translacional , Administração Intravenosa , Vesícula Biliar/patologia , Antibacterianos/administração & dosagem
15.
Rev. Bras. Saúde Mater. Infant. (Online) ; 17(4): 853-858, Oct.-Dec. 2017. graf
Artigo em Inglês | LILACS | ID: biblio-1013052

RESUMO

Abstract Introduction: sepsis is a serious public health problem, affecting millions of people in the world each year, with a high mortality rate (one out of four patients) and an increasing incidence. Sepsis is one of the main causes of maternal mortality and an important cause of admission to obstetric intensive care units. Case description: In this study, the authors report the case of a woman having been submitted to cesarean section three days before presenting clinical signs of sepsis and septic shock caused by a liver abscess. The patient had a set of complications secondary to shock, such as thrombocytopenia, coagulopathy, toe ischemia and acute kidney failure. The patient had cholelithiasis and recurrent pain in the right hypochondrium during pregnancy. During hospitalization, the mechanism involved in the development of hepatic abscess was infection of the biliary tract. The patient was treated in an obstetric intensive care unit with antibiotics and drainage of the liver abscess. Progress was favorable and the patient was discharged in good health. Discussion: pyogenic liver abscess during pregnancy and puerperium is a serious condition which represents a diagnostic and therapeutic challenge, with few cases reported. The normally nonspecific clinical and laboratory findings can lead to a late diagnosis, which increases the risk of maternal morbidity and mortality.


Resumo Introdução: a sepse é um problema grave de saúde pública, afetando milhões de pessoas no mundo a cada ano. Apresenta uma alta mortalidade, um em quatro doentes, e vem aumentando sua incidência. É uma das principais causas de mortalidade materna, sendo uma causa importante de admissões emunidades de terapia intensiva obstétrica. Descrição do caso: puérpera, no terceiro dia pós-cesariana, apresentou quadro clinico de sepse e choque séptico secundário a um abscesso hepático piogênico.Evoluiu com complicações secundárias ao choque: plaquetopenia, coagulopatia, isquemia de pododáctilos e insuficiência renal aguda. A paciente era portadora de colelitíase e apresentou repetidas crises álgicas em hipocôndrio direitodurante a gestação.Durante o internamento, ficou definido que a causa do abscesso hepático foi a infecção das vias biliares.Realizou-se tratamento em unidade de terapia intensiva obstétrica, tendo a paciente sido submetida à drenagem do abscesso hepático e antibioticoterapia. A evolução foi satisfatória e a paciente obteve alta em boas condições. Discussão: o abscesso hepático piogênico durante a gravidez e o puerpério é uma condição extremamente grave, com poucos casos relatados, representando um desafio diagnóstico e terapêutico. Como os achados clínicos e laboratoriais são usualmente inespecíficos, um diagnóstico retardado é possível, aumentando os riscos de morbidade e mortalidade materna em casos não tratados precocemente.


Assuntos
Humanos , Feminino , Adulto , Choque Séptico/complicações , Colelitíase , Sepse/diagnóstico , Abscesso Hepático Piogênico , Período Pós-Parto , Complicações na Gravidez , Doenças dos Ductos Biliares , Transtornos da Coagulação Sanguínea , Brasil , Mortalidade Materna , Mortalidade , Insuficiência Renal , Unidades de Terapia Intensiva
16.
Acta cir. bras ; 32(10): 881-890, Oct. 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-886172

RESUMO

Abstract Purpose: To evaluate respiratory muscle strength (PImax and PEmax) before and 24 and 48 h after conventional and single-port laparoscopic cholecystectomy. Methods: Forty women with symptomatic cholelithiasis (18 to 70 years) participated in the study. The patients were divided into two groups: 21 patients undergoing conventional laparoscopic cholecystectomy and 19 patients undergoing single-port laparoscopic cholecystectomy. Differences were considered to be significant when p<0.05. Results: The results showed a greater decline in PImax after 24 h in the group submitted to conventional laparoscopic cholecystectomy, with a significant difference between groups (p=0.0308). Conclusion: Recovery of the parameters studied was more satisfactory and respiratory muscle strength was less compromised in the group submitted to single-port laparoscopic cholecystectomy.


Assuntos
Humanos , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Músculos Respiratórios/fisiologia , Colelitíase/cirurgia , Colecistectomia Laparoscópica/métodos , Força Muscular/fisiologia , Fatores de Tempo , Estudos Transversais , Estudos Prospectivos , Resultado do Tratamento
17.
Rev. cuba. cir ; 56(3): 1-6, jul.-set. 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-900984

RESUMO

El vólvulo de la vesícula biliar es una enfermedad rara y poco frecuente de difícil diagnóstico de manera preoperatoria, ya que las manifestaciones clínicas son atribuidas a otras enfermedades. Se presenta un caso de una paciente femenina de 84años de edad que ingresó en el servicio de cirugía general con un cuadro de dolor abdominal a tipo cólico en hipocondrio derecho acompañado de náusea y vómitos con restos de alimentos. Se realizó examen físico y se indicó ultrasonido abdominal. Se interpretó como una colecistitis aguda litiásica. Se impuso un tratamiento con ceftriaxone. Dado su evolución no desfavorable, cinco días después de su ingreso se realizó la colecistectomía donde se encuentra órgano volvulado. La biopsia confirma colecistitis aguda gangrenada. La paciente evolucionó satisfactoriamente. Tres días posteriores a la cirugía egresó de la institución(AU)


Gallbladder volvulus is a rare and infrequent disease difficult to diagnose preoperatively, as clinical manifestations are attributed to other diseases. A case is presented of an 84-year-old female patient who entered the general surgery service with abdominal colicky pain to the right hypochondrium accompanied by nausea and vomiting with food remains. A physical examination was performed and abdominal ultrasound was indicated. It was interpreted as acute lithiasic cholecystitis. Ceftriaxone was prescribed. Given the unfavorable evolution five days after admission, the cholecystectomy was performed, where the volvulus was found. The biopsy confirms acute gangrenous cholecystitis. The patient evolved satisfactorily. Three days after the surgery he was discharged from the institution(AU)


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Colecistectomia/métodos , Colecistolitíase/tratamento farmacológico , Colelitíase/diagnóstico , Vesícula Biliar/diagnóstico por imagem , Volvo Gástrico/diagnóstico por imagem
18.
Acta cir. bras ; 32(6): 475-481, June 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-886205

RESUMO

Abstract Purpose: To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port. Methods: Twenty-one patients were included in the conventional laparoscopic cholecystectomy group and 19 other patients in the single-port laparoscopic cholecystectomy group. A VAS was used for the assessment of postoperative pain at three time points. Differences were considered statistically significant when p<0.05. Results: Intergroup analysis showed no significant difference in VAS scores between the conventional laparoscopic cholecystectomy and single-port laparoscopic cholecystectomy groups at any of the time points studied. Conclusion: This study found no significant difference in postoperative pain between the two groups.


Assuntos
Humanos , Feminino , Adulto , Dor Pós-Operatória , Colelitíase/cirurgia , Colecistectomia Laparoscópica/métodos , Estudos Transversais , Estudos Prospectivos
19.
Rev. chil. cir ; 69(3): 196-201, jun. 2017. graf, tab
Artigo em Espanhol | LILACS | ID: biblio-844359

RESUMO

Objetivo: Analizar datos relacionados con el programa «Colecistectomía como prevención del cáncer de vesícula biliar¼. Método: Se analizan los resultados obtenidos de la página web del DEIS del Ministerio de Salud chileno. Resultados: El año 2006, fecha de inicio del programa, fueron egresados 42.780 pacientes entre 20 y 64 años con diagnósticos correspondientes a los códigos CIE-10, K80-K83. El año 2012, el número de egresos fue de 58.818, lo que significó que desde el año 2006 fueron egresados 39.419 pacientes más que si se hubiesen mantenido los números del año 2006. Por otra parte, desde antes de la puesta en práctica del programa, se aprecia una disminución de la mortalidad ajustada por edad del cáncer de vesícula. Conclusión: Aunque desde la puesta en marcha del programa de prevención del cáncer de vesícula se observa un aumento en el número de casos intervenidos, especialmente durante los años 2011 y 2012, la caída de la tasa de mortalidad parece deberse a factores diferentes al aumento de las colecistectomías.


Goal: To evaluate published data related to the program ‘Cholecystectomy as prevention of Gallbladder Cancer’. Method: Analysis of the results obtained from the DEIS web page (Ministry of Health of Chile). Results: Since 2006, The Chile Ministry of Health began a program to reduce the number of gallbladder cancer cases in Chile. To accomplish the above, Chile Government has guarantied the execution of a cholecystectomy program under parameters of quality, opportunity and financial support between the ages of 35 and 49 years old. During 2006, 42,780 patients corresponding to the ICD 10 codes, K80-K83 between 20 and 64 years old were discharged from Chilean Hospitals. In 2012, six years after the beginning of the program, 58,818 were discharged. The program would make done possible to discharge approximately 39,419 extra patients. On the other hand, during the last ten years, a decrease in the mortality rate of gallbladder cancer has been observed in Chile. Conclusion: Although since the beginning of the program an increase in the number of patients discharged is observed, the decrease in the gallbladder cancer mortality seems not to have relation with the program.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Colecistectomia/estatística & dados numéricos , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/prevenção & controle , Distribuição por Idade , Chile/epidemiologia , Colelitíase/cirurgia , Neoplasias da Vesícula Biliar/cirurgia , Alta do Paciente/estatística & dados numéricos , Fatores Sexuais
20.
Rev. Fac. Cienc. Méd. Univ. Cuenca ; 35(1): 85-89, Abril 2017. ilus
Artigo em Espanhol | LILACS | ID: biblio-999149

RESUMO

El Íleo biliar es la obstrucción intestinal mecánica secundaria al impacto intraluminal de un lito; considerada como una complicación de la colelitiasis que fistuliza al tubo digestivo, permitiendo la migración del lito, en ocasiones ocurre por paso natural a través de la vía biliar debido a alteraciones del esfínter de Oddi, sobre todo tras la ampliación quirúrgica del mismo.Patología rara que se presenta más en ancianos, la ma-yoría de las series internacionales indican que el promedio de edad en la que se presenta es entre los 60 y 84 años. Afecta principalmente al sexo femenino, con una rela-ción hombre: mujer que va de 1:3 a 1:6, atribuyéndose a la mayor frecuencia de patología biliar en dicho sexo. Esta condición se precede de un cuadro de colecistitis aguda o crónica (75% de los casos). REPORTE DEL CASO Se presenta el caso de un paciente masculino de 83 años, quien acude al servicio de emergencia por pre-sentar dolor más distensión abdominal, nausea y vómito, al examen físico se puede observar un abdomen distendido, con ruidos hidroaéreos abolidos, timpánico a la percusión, doloroso a la palpación profusa. Se le realizan exámenes de laboratorio los cuales indican fórmula leucocitaria incrementada, PCR incrementado mínimamente sobre el límite superior, los exámenes de imagen específicamente la TAC nos indica la existencia de gas en vía biliar y una imagen hiperdensa a nivel de intestino delgado. Cuadro doloroso abdominal se exacerba, persiste distensión abdominal y los ruidos hi-droaereos se mantienen abolidos por lo cual se proyecta una laparotomía exploratoria.


Biliary ileus is the secondary mechanical intestinal obstruction to the intraluminal impact of a litho; it is consi-dered as a complication of cholelithiasis that provokes a fistula in the digestive tract, allowing the migration of the stones. Sometimes occurs by natural passage throu-gh the biliary tract due to alterations of the sphincter of Oddi, especially after the surgical extension of the same.It is a rare pathology that is more common in the elderly, the most international series report an average age be-tween 60 and 84 years.It mainly affects the female sex, with a male relation: female ratio ranging from 1: 3 to 1: 6, attributed to the higher frequency in that sex biliary disease. This condi-tion is preceded by acute or chronic cholecystitis (75% of cases). CASE REPORT It is a case of a man, he is 83-year-old and he goes to emergency service presenting pain and bloating, nausea and vomit, in the physical examination it was observed a distended abdomen with abolished bowel sounds, tympanic to percussion, painful to profuse pal-pation. Laboratory tests are performed and indicate an increased leukocyte count, CRP increased minimally over the upper limit, imaging examinations CT specifi-cally indicates the existence of gas in bile duct and a hyper dense image at the level of the small intestine. The patient still presents pain, for this reason it is projec-ted an exploratory laparotomy.


Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Colelitíase , Íleo , Obstrução Intestinal , Patologia , Ductos Biliares , Tomografia
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