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2013, Número 5

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Cir Cir 2013; 81 (5)


Reparación de colédoco con autoinjerto de peritoneo

leana Lorenzana-Bautista I, Flores-Plascencia A, Barrios-Pineda FJ, Alderete-Vázquez G, Sánchez-Valdivieso EA

Idioma: Español
Referencias bibliográficas: 50
Paginas: 373-382
Archivo PDF: 306.02 Kb.


RESUMEN

Antecedentes: un número significativo de individuos sufrirá daño por iatrogenia del colédoco durante colecistectomías laparoscópicas. Las derivaciones bilio-digestivas pueden complicarse con estenosis y sepsis biliar y afectar la calidad y expectativa de vida. Para evitar la derivación se utilizan injertos sintéticos.
Objetivo: evaluar el implante autólogo de peritoneo en la reparación de colédoco.
Material y métodos: estudio experimental efectuado en 10 conejos Nueva Zelanda adultos a los que se les resecó un segmento del colédoco y para la reparación término-terminal de la vía biliar se construyó un neo-conducto con peritoneo parietal como auto-injerto. Se vigilaron con controles semanales de bilirrubinas y transaminasas. A la necropsia programada se estudió el segmento injertado, se realizó biopsia hepática durante el procedimiento y la autopsia.
Resultados: los animales no mostraron alteraciones en sus hábitos normales, la herida quirúrgica no tuvo complicaciones, no cursaron con ictericia y a la necropsia el segmento injertado se apreció totalmente integrado. En dos animales hubo como complicación un bilioma y un absceso hepático. El daño hepático observado inicialmente fue disminuyendo a lo largo del seguimiento.
Discusión: nuestros resultados se equiparan con ventaja con los métodos conocidos de reparación de vías biliares, especialmente en lesiones severas (Bismuth-Strasberg E1-3). Adolece de las complicaciones de las derivaciones bilio-digestivas, no es caro como los injertos sintéticos y es de mucho más fácil construcción que el injerto de amnios humano.
Conclusiones: el auto-injerto de peritoneo es un procedimiento adecuado como alternativa para tratar lesiones circunferenciales de colédoco.


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