RESUMEN
Introduction Cholelithiasis usually can be managed successfully by endoscopic sphincterotomy. Choledochoduodenostomy (CDD) is one of the surgical treatment options but its acceptance remains debated because of the risk of reflux cholangitis and sump syndrome. The aim of this study was to assess the current features and outcomes of patient undergoing CDD. Patients and methods We retrospectively analysed the surgical results of consecutive 130 patients treated by CDD between 1991 and 2013 and excluded five cases with a malignant disorder. Indications for surgery included endoscopic management where stones were difficult or failed to pass and primary common bile duct stones with choledochal dilatation. Incidences of reflux cholangitis, stone recurrence, pancreatitis or sump syndrome were investigated and the data between end-to-side and side-to-side CDD were compared. Results Reflux cholangitis and stone recurrence was 1.6% (2/125) and 0% (0/125) of cases by CDD. There is no therapeutic-related pancreatitis in CDD. Sump syndrome was not also observed in side-to-side CDD. Conclusions This study is a first comparative study between end-to-side and side-to-side CDD. The surgical outcomes for CDD treatment of choledocholithiasis were acceptable. The incidence of reflux cholangitis, stone recurrence, pancreatitis and sump syndrome was very low.
Asunto(s)
Coledocostomía/métodos , Colelitiasis/cirugía , Duodenostomía/métodos , Anciano , Colangitis/etiología , Coledocostomía/efectos adversos , Coledocostomía/estadística & datos numéricos , Duodenostomía/efectos adversos , Duodenostomía/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Pancreatitis/etiología , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction after excision are hepaticoduodenostomy (HD) and Roux-en-Y hepaticojejunostomy (HJ), of which the HJ is favored by most surgeons. Evidence concerning the optimal method of reconstruction is, however, sparse. MATERIALS AND METHODS: Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library. Suitable studies were chosen and data extracted for meta-analysis. Outcomes evaluated included operative time, hospital stay and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction and re-operative rate. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables. RESULTS: Six retrospective studies were included in this meta-analysis, comprising a total of 679 patients, 412 of whom (60.7%) underwent HD, and the remainder, 267 (39.3%) underwent HJ. Although, HD group had slightly shorter hospital stay (MD: 0.30; 95% CI: -0.22-0.39; P < 0.00001) it showed a higher incidence of postoperative reflux/gastritis (OR: 0.08; 95% CI: -0.02-0.39; P = 0.002). However, the other outcomes such as bile leak, cholangitis, anastomotic stricture, bleeding, operative time, reoperation rate and adhesive intestinal obstruction did not differ between HD and HJ groups. CONCLUSIONS: HD shows higher postoperative reflux/gastritis than HJ but a shorter hospital stay. There are few good-quality studies that compare the outcomes from HD and HJ, meaning that caution should be exercised in the generalization of the results of this meta-analysis, which suggests HD to be comparable with HJ in terms of other complications, operative benefits and outcomes.
Asunto(s)
Quiste del Colédoco/cirugía , Duodenostomía/métodos , Yeyunostomía/métodos , Hígado/cirugía , Anastomosis en-Y de Roux , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Bilis , Colangitis/epidemiología , Colangitis/etiología , Constricción Patológica , Duodenostomía/estadística & datos numéricos , Gastritis/epidemiología , Gastritis/etiología , Humanos , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/etiología , Yeyunostomía/estadística & datos numéricos , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Duodenostomía/métodos , Yeyunostomía/métodos , Yeyuno/anomalías , Yeyuno/cirugía , Anomalías Congénitas/clasificación , Anomalías Congénitas/epidemiología , Anomalías Congénitas/cirugía , Duodenostomía/estadística & datos numéricos , Duodenostomía/tendencias , Humanos , Incidencia , Yeyunostomía/estadística & datos numéricos , Yeyunostomía/tendencias , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Se presenta un caso clínico de una paciente que con fines suicidas ingiere 200 cc de ácido sulfúrico. Durante 464 días, tiempo durante el cual fue tratada, presenta diversas complicaciones gastrointestinales, pulmonares, metabólicas y sistémicas, motivo por el cual fue sometida a diversos tratamientos médico-quirúrgicos. Fue dada de alta en forma definitiva en julio de 1998
Asunto(s)
Humanos , Femenino , Adulto , Ácidos Sulfúricos/efectos adversos , Cáusticos/efectos adversos , Pancreaticoduodenectomía , Perforación del Esófago/cirugía , Peritonitis/cirugía , Duodenostomía/estadística & datos numéricos , Duodeno/lesiones , Gastrostomía/estadística & datos numéricos , Páncreas/lesiones , Lavado Peritoneal/estadística & datos numéricos , Síndrome de Dificultad Respiratoria del Recién Nacido , Intento de Suicidio , YeyunostomíaRESUMEN
Se describe una técnica para facilitar la exploración, esfinterotomía y esfinteroplastia transduodenal, con la ayuda de la bujía de Phillips. El uso de esta técnica no produjo lesiones ni falsas vías. La duodenotomía fue pequeña, hubo buena exposición de la papila y se obtuvo una correcta dirección de la incisión