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2018, Número 6

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Cir Cir 2018; 86 (6)


Factores de riesgo asociados a las complicaciones y a la falla terapéutica en las reconstrucciones de lesiones de vía biliar secundarias a colecistectomía

Martínez-Mier G, Luna-Ortiz HJ, Hernández-Herrera N, Zilli-Hernandez S, Lajud-Barquin FA

Idioma: Español
Referencias bibliográficas: 28
Paginas: 491-498
Archivo PDF: 192.76 Kb.


RESUMEN

Antecedentes: Las lesiones de vías biliares por colecistectomía son una complicación seria. Numerosos factores alteran el resultado de su reconstrucción. Método: Evaluación de la reconstrucción de lesiones de vía biliar y sus factores de riesgo (de enero de 2008 a enero de 2017). Resultados: Se evaluaron 58 pacientes (72.4% mujeres; media de edad 41.8 años). El 67.8% tuvo colecistectomía laparoscópica como cirugía inicial. El 79.3% se diagnosticó posoperatoriamente. La referencia promedio fue 9 semanas y su reparación temprana (‹ 1 semana) ocurrió en el 27.6%. La lesión más común fue Amsterdam tipo D (55.2%) y Bismuth-Strasberg E4 (34.5%). La morbilidad fue del 39.6% (fuga biliar 10.3%, estenosis 6.9% y colangitis recurrente12.1%), con un 3% de mortalidad perioperatoria. Se logró un éxito del 81% de acuerdo con la clasificación de McDonald. Los factores de riesgo para las complicaciones fueron baja hemoglobina, baja albúmina, baja fosfatasa alcalina, tutores biliares y lesiones E3-E5 (análisis univariado). Los factores de riesgo para falla terapéutica fueron la reparación previa en otro centro, los tutores biliares y la reparación posterior a 1 semana tras la lesión (univariado y multivariado). Conclusión: Pueden obtenerse buenos resultados en las reconstrucciones de vías biliares en centros especializados. Existen algunos factores de riesgo para los resultados de las reconstrucciones que deben de ser validados.


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