Resumo

HOYOS, Sergio Iván  e  QUINTERO, Víctor Manuel. Iatrogenic lesions of the biliary ducts: experience at the Hepatobiliary and Pancreatic Unit of Pablo Tobón Uribe Hospital (Medelín, Colombia). rev. colomb. cir. [online]. 2009, vol.24, n.4, pp.244-249. ISSN 2011-7582.

Introduction. Iatrogenic operative injuries of the biliary ducts constitute a surgical challenge; these lesions, though of low incidence, are highly complex, requiring interdisciplinary management to obtain suitable results and avoid devastating future complications. Objectives. To review a series of patients referred to the Hepatobiliary and Pancreatic Unit of Pablo Tobón Uribe Hospital (Medellín, Colombia), and to analyze results and complications during the hospital stay. Patients and methods. A series of 33 patients was collected covering the period January 1, 2003, to April 30, 2008, admitted for management at our reference hospital; 77% were women, 27% men, with an average age of 42 years. All were referred by other hospitals in the city. Results. Initial surgical intervention was by laparoscopy in 48% and open laparotomy in 52%. Clinical manifestations were jaundice (91%), pain (70%), and cholangitis (42%); 52% of the patients presented bile peritonitis. MRCP (magnetic resonance cholangiopancreatography) was done in 67% of the patients, followed by ERCP in 61%. The surgical procedures performed were bilioenteric anastomosis in 27 patients (82%), liver transplantation in 2 (6%), and sole exploratory laparotomy in (6%). Average hospital stay was 6.8 days. Postoperative complications developed in 21%; there were no cases of biliary leak. Average postoperative follow-up was 14.9 months (1 to 56 months), 78% of patients with bilioenteric anastomoses are asymptomatic, 14% developed cholestasis, and 4% stricture. There was only one death due to sepsis. Conclusion. Iatrogenic bile ducts injuries are complex lesions that require interdisciplinary expert management at a reference center so as to achieve long term better prognoses.

Palavras-chave : common bile duct; biliary tract surgical procedures; cholecystectomy; complications.

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