Morbimortalidad de la colecistectomía laparoscópica electiva en un servicio universitario
Palabras clave:
COLECISTECTOMÍA LAPAROSCÓPICA, COMPLICACIONES POSOPERATORIAS, MORBIMORTALIDAD
Resumen
Introducción: la colecistectomía laparoscópica (CL) es la cirugía más frecuente del tracto digestivo. A pesar de considerarse un procedimiento seguro, la morbilidad se reporta hasta en un 10%, no existiendo registro a nivel nacional. Objetivo: describir la incidencia de complicaciones y morbimortalidad de la CL electiva en una población no seleccionada de un servicio universitario. Método: se realizó un estudio retrospectivo observacional de los pacientes intervenidos en forma electiva de CL, entre el 1/1/2010 y el 31/12/2019 en la Clínica Quirúrgica B del Hospital de Clínicas y en la Unidad Docente Asistencial de Cirugía del Hospital Español. Las variables incluidas fueron demográficas, diagnóstico operatorio, conversión, morbimortalidad, reintervenciones y readmisiones.
Resultados: se reclutó un total de 1.499 CL electivas, edad promedio 49 años (15-87), 79% sexo femenino, incidencia de litiasis de vía biliar principal (LVBP) en 210 (17%) casos; 25 conversiones (1,7%). Hubo un total de 64 complicaciones (4,3%) con una incidencia significativamente mayor en pacientes con LVBP (2,8% vs 7,6%, p 0,01). Hubo dos lesiones del hepato-colédoco (0,13%) (tipo Hannover D y C), ambas detectadas y reparadas en la misma cirugía y tres lesiones viscerales (0,20%). Hubo 16 readmisiones (1,07%) y 9 reintervenciones (0,6%). Dos pacientes fallecieron (0,13%) en el posoperatorio (insuficiencia hepatocítica crónica descompensada y pancreatitis grave pos-CPRE posoperatoria). Conclusiones: la CL en la población no seleccionada del servicio universitario analizado en este trabajo demuestra ser un procedimiento seguro, con tasas de complicaciones, reintervenciones y readmisiones que en este estudio se comparan favorablemente con las reportadas en la literatura. La presencia de litiasis en la vía biliar principal se asoció a una incidencia significativamente mayor de complicaciones posoperatorias y de mayor severidad.
Citas
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(12) Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: treatment and outcome from a national perspective. World J Surg 2016; 40(1):73-80. doi: 10.1007/s00268-015-3281-4.
(13) Cohen J, Charpentier K, Beard R. An Update on Iatrogenic Biliary Injuries: Identification, Classification, and Management. Surg Clin North Am 2019; 99(2):283-99. doi: 10.1016/j.suc.2018.11.006.
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(21) Nakazato T, Su B, Novak S, Deal S, Kuchta K, Ujiki M. Improving attainment of the critical view of safety during laparoscopic cholecystectomy. Surg Endosc 2020; 34(9):4115-23. doi: 10.1007/s00464-019-07178-y.
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(24) Sajid M, Leaver C, Haider Z, Worthington T, Karanjia N, Singh K. Routine on-table cholangiography during cholecystectomy: a systematic review. Ann R Coll Surg Engl 2012; 94(6):375-80. doi: 10.1308/003588412X13373405385331.
(25) Ford J, Soop M, Du J, Loveday B, Rodgers M. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 2012; 99(2):160-7. doi: 10.1002/bjs.7809.
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(27) Strasberg S. Biliary injury in laparoscopic surgery: part 2. Changing the culture of cholecystectomy. J Am Coll Surg 2005; 201(4):604-11. doi: 10.1016/j.jamcollsurg.2005.04.032.
(28) Connor S, Perry W, Nathanson L, Hugh T, Hugh T. Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist. HPB (Oxford) 2014; 16(5):422-9. doi: 10.1111/hpb.12161.
(29) Rosero E, Joshi G. Hospital readmission after ambulatory laparoscopic cholecystectomy: incidence and predictors. J Surg Res 2017; 219:108-115. doi: 10.1016/j.jss.2017.05.071.
(30) Soler-Dorda G, San Emeterio González E, Martón Bedia P. Factores asociados a ingreso no previsto tras colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria. Cir Esp 2016; 94(2):93–9. doi: 10.1016/j.ciresp.2014.09.018.
(31) Suuronen S, Kivivuori A, Tuimala J, Paajanen H. Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland. BMC Surg 2015; 15:97. doi: 10.1186/s12893-015-0085-2.
(32) Machado N. Laparoscopic cholecystectomy in cirrhotics. JSLS 2012; 16(3):392-400. doi: 10.4293/108680812X13462882736493.
(33) United Kingdom. National Health Service. Gallbladder removal: complications. Disponible en: https://www.nhs.uk/ conditions/gallbladder-removal/risks/. (Consulta: 22 noviembre 2020).
(34) American College of Surgeons. Surgical patient education. Cholecystectomy. Disponible en: https://www. facs.org/~/ media/files/education/patient%20ed/cholesys.ashx. [Consulta: 23 noviembre 2020].
(2) Bonilla F, Almada M, Canessa C. Cirugía del día: colecistectomía laparoscópica. ¿Es factible en nuestro medio? Rev Méd Urug 2016; 32(4):274-80. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/153/155. (Consulta: 23 noviembre 2020).
(3) Pucher P, Brunt L, Davies N, Linsk A, Munshi A, Rodríguez H, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc 2018; 32(5):2175-83. doi: 10.1007/s00464-017-5974-2.
(4) Amreek F, Hussain S, Mnagi M, Rizwan A. Retrospective Analysis of Complications Associated with Laparoscopic Cholecystectomy for Symptomatic Gallstones. Cureus 2019; 11(7):e5152. doi: 10.7759/cureus.5152.
(5) CholeS Study Group, West Midlands Research Collaborative. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases. Br J Surg 2016; 103(12):1704-15. doi: 10.1002/bjs.10287
(6) Dalwani A, Shaikh R, Das K, Devrajani T, Shah S, Shah A. Complications of laparoscopic cholecystectomy at Liaquat University, Jamshoro. World App Sci J 2013; 23(6):808-11. doi:10.5829/idosi.wasj.2013.23.06.7477.
(7) Donkervoort S, Kortram K, Dijksman L, Boermeester M, van Ramshorst B, Boerma D. Anticipation of complications after laparoscopic cholecystectomy: prediction of individual outcome. Surg Endosc 2016; 30(12):5388-94. doi: 10.1007/s00464-016-4895-9.
(8) Alli V, Yang J, Xu J, Bates A, Pryor A, Talamini M, et al. Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience. Surg Endosc 2017; 31(4):1651-8. doi: 10.1007/s00464-016- 5154-9.
(9) Barrett M, Asbun H, Chien H, Brunt L, Telem D. Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc 2018; 32(4):1683-8. doi: 10.1007/s00464-017-5847-8.
(10) Fry D, Pine M, Pine G. Ninety-day postdischarge outcomes of inpatient elective laparoscopic cholecystectomy. Surgery 2014; 156(4):931-6. doi: 10.1016/j.surg.2014.06.023.
(11) Stewart L. Iatrogenic biliary injuries: identification, classification, and management. Surg Clin North Am 2014; 94(2):297-310. doi: 10.1016/j.suc.2014.01.008.
(12) Rystedt J, Lindell G, Montgomery A. Bile duct injuries associated with 55,134 cholecystectomies: treatment and outcome from a national perspective. World J Surg 2016; 40(1):73-80. doi: 10.1007/s00268-015-3281-4.
(13) Cohen J, Charpentier K, Beard R. An Update on Iatrogenic Biliary Injuries: Identification, Classification, and Management. Surg Clin North Am 2019; 99(2):283-99. doi: 10.1016/j.suc.2018.11.006.
(14) Wu Y, Linehan D. Bile duct injuries in the era of laparoscopic cholecystectomies. Surg Clin North Am 2010; 90(4):787-802. doi: 10.1016/j.suc.2010.04.019.
(15) Berci G, Hunter J, Morgenstern L, Arregui M, Brunt M, Carroll B, et al. Laparoscopic cholecystectomy: first, do no harm; second, take care of bile duct stones. Surg Endosc 2013; 27(4):1051-4. doi: 10.1007/s00464-012-2767-5.
(16) Fong Z, Pitt H, Strasberg S, Loehrer A, Sicklick J, Talamini M, et al. Diminished survival in patients with bile leak and ductal injury: management strategy and outcomes. J Am Coll Surg 2018; 226(4):568-576.e1. doi: 10.1016/j.jamcollsurg.2017.12.023.
(17) Pekolj J, Álvarez F, Palavecino M, Sánchez Clariá R, Mazza O, de Santibañes E. Intraoperative management and repair of bile duct injuries sustained during 10,123 laparoscopic cholecystectomies in a high-volume referral center. J Am Coll Surg 2013; 216(5):894-901. doi: 10.1016/j.jamcollsurg.2013.01.051.
(18) Strasberg S, Hertl M, Soper N. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180(1):101-25.
(19) Ferreres A, Asbun H. Technical aspects of cholecystectomy. Surg Clin North Am 2014; 94(2):427-54. doi: 10.1016/j.suc.2014.01.007.
(20) Strasberg S. Commentary on: Feasibility and Value of the Critical View of Safety in Difficult Cholecystectomies. Ann Surg 2019; 269(4):e42. doi: 10.1097/SLA.0000000000003103.
(21) Nakazato T, Su B, Novak S, Deal S, Kuchta K, Ujiki M. Improving attainment of the critical view of safety during laparoscopic cholecystectomy. Surg Endosc 2020; 34(9):4115-23. doi: 10.1007/s00464-019-07178-y.
(22) Nijssen M, Schreinemakers J, Meyer Z, van der Schelling G, Crolla R, Rijken A. Complications after laparoscopic cholecystectomy: a video evaluation study of whether the critical view of safety was reached. World J Surg 2015; 39(7):1798-803. doi: 10.1007/s00268-015-2993-9.
(23) Niemann A, Matusko N, Sandhu G, Varban O. Assessing the effect of the critical view of safety criteria on simulated operative decision-making: a pilot study. Surg Endosc 2019; 33(3):911-6. doi: 10.1007/s00464-018-6385-8.
(24) Sajid M, Leaver C, Haider Z, Worthington T, Karanjia N, Singh K. Routine on-table cholangiography during cholecystectomy: a systematic review. Ann R Coll Surg Engl 2012; 94(6):375-80. doi: 10.1308/003588412X13373405385331.
(25) Ford J, Soop M, Du J, Loveday B, Rodgers M. Systematic review of intraoperative cholangiography in cholecystectomy. Br J Surg 2012; 99(2):160-7. doi: 10.1002/bjs.7809.
(26) Way L, Stewart L, Gantert W, Liu K, Lee C, Whang K, et al. Causes and prevention of laparoscopic bile duct injuries: analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg 2003; 237(4):460-9. doi: 10.1097/01.SLA.0000060680.92690.E9.
(27) Strasberg S. Biliary injury in laparoscopic surgery: part 2. Changing the culture of cholecystectomy. J Am Coll Surg 2005; 201(4):604-11. doi: 10.1016/j.jamcollsurg.2005.04.032.
(28) Connor S, Perry W, Nathanson L, Hugh T, Hugh T. Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist. HPB (Oxford) 2014; 16(5):422-9. doi: 10.1111/hpb.12161.
(29) Rosero E, Joshi G. Hospital readmission after ambulatory laparoscopic cholecystectomy: incidence and predictors. J Surg Res 2017; 219:108-115. doi: 10.1016/j.jss.2017.05.071.
(30) Soler-Dorda G, San Emeterio González E, Martón Bedia P. Factores asociados a ingreso no previsto tras colecistectomía laparoscópica en régimen de cirugía mayor ambulatoria. Cir Esp 2016; 94(2):93–9. doi: 10.1016/j.ciresp.2014.09.018.
(31) Suuronen S, Kivivuori A, Tuimala J, Paajanen H. Bleeding complications in cholecystectomy: a register study of over 22,000 cholecystectomies in Finland. BMC Surg 2015; 15:97. doi: 10.1186/s12893-015-0085-2.
(32) Machado N. Laparoscopic cholecystectomy in cirrhotics. JSLS 2012; 16(3):392-400. doi: 10.4293/108680812X13462882736493.
(33) United Kingdom. National Health Service. Gallbladder removal: complications. Disponible en: https://www.nhs.uk/ conditions/gallbladder-removal/risks/. (Consulta: 22 noviembre 2020).
(34) American College of Surgeons. Surgical patient education. Cholecystectomy. Disponible en: https://www. facs.org/~/ media/files/education/patient%20ed/cholesys.ashx. [Consulta: 23 noviembre 2020].
Publicado
2021-03-31
Cómo citar
1.
Haro Bello C, Brito Viglione N, Pouy De la Plaza A, Bonilla Cal F, Muniz Locatelli N, Cubas Bozzolo S, Canessa Sorin C. Morbimortalidad de la colecistectomía laparoscópica electiva en un servicio universitario. Rev. Méd. Urug. [Internet]. 31 de marzo de 2021 [citado 14 de noviembre de 2024];37(1):e37103. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/671
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