RESOLUCIÓN QUIRÚRGICA DE LAS LESIONES IATROGÉNICAS DE LA VÍA BILIAR. HOSPITAL LUIS VERNAZA. 2014 - 2016.

Abstract

Introduction: Iatrogenic bile duct injury is defined as an injury to some part of the extra hepatic biliary tract during cholecystectomy or other invasive procedures, considered as the result of incorrect identification of the elements of the Calot triangle. (1) (2) Treatment depending on severity may be conservative, endoscopic, use of drainage and splints with interventional or surgical radiology techniques. (3) (4) (5) Objective: To determine the management used for the surgical resolution of iatrogenic lesions of the bile duct. Materials and Methods: A descriptive, observational, retrospective, non-experimental study of 27 patients with iatrogenic lesion of the biliary tract admitted to the general surgery room of the Luis Vernaza Hospital during the period from February 2014 to December 2016. Results: Of the 27 evaluated with iatrogenic injury of the bile duct, 78% (21) were female; 37% (10) were older than 50 years; 74% (20) came from other hospitals. The 70% (19) of the lesions were posterior to open cholecystectomy, the diagnostic time in 89% (24) was in the postoperative period. The definitive treatment of patients with iatrogenic bile duct injury according to the Strasberg - Bismuth classification, type A lesion was present in 26% (7), treated in 100% (7) with Cpre Stent; 15% (4) lesion type C, treated in 75% (3) with Cpre stent and in 25% (1) with primary raffia; 15% (4) lesion type E3, treated in 100% with Hepatic jejunum Roux-en-Y anastomosis; 11% (3) D type injury, treated in 33% (1) Cpre stent, 33% (1) percutaneous drainage, 33% (1) primary raffia; In addition 11% (3) injury type E1; 11% (3) lesion type E4, 4% (1) lesion type B; 4% (1) lesion type E2, 4% (1) lesion type E5, were treated in 100% with Hepatic and jejunal anastomosis in Roux-en-Y. Septic complications occurred in 81% (17) during the postoperative period, with a mortality rate of 22% (6). Conclusions: Bile duct lesions were present after open cholecystectomy, diagnosed for the most part in the postoperative period, in relation to the definitive treatment of patients with iatrogenic bile duct injury according to the Strasberg - Bismuth classification. Lesions type A, type C, type D were treated with Cpre Stent; A type B lesion and all E-type lesions were treated with the Hepatic jejunal anastomosis technique in Roux-en-Y, septic complication was the main, 22% mortality.