Morbimortality of elective laparoscopic cholecystectomy in a university hospital
DOI:
https://doi.org/10.29193/RMU.37.1.2Keywords:
LAPAROSCOPIC CHOLECYSTECTOMY, POSOPERATIVE COMPLICATIONS, MORBIMORTALITYAbstract
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.
References
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(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].
(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/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].
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Published
2021-03-31
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Haro Bello C, Brito Viglione N, Pouy De la Plaza A, Bonilla Cal F, Muniz Locatelli N, Cubas Bozzolo S, et al. Morbimortality of elective laparoscopic cholecystectomy in a university hospital. Rev. Méd. Urug. [Internet]. 2021 Mar. 31 [cited 2024 Dec. 22];37(1):e37103. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/671
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