Surgical injury of the bile ducts in residents. Experience of a university training center
Bile duct surgical injury (LQVB) is a dangerous complication of cholecystectomy, with significant postoperative sequelae. These have an estimated laparoscopic incidence of 0.4% to 1.5%. The aim of this study was to evaluate the incidence of LQVB during the training of the surgeon and the impact on m...
| Autores principales: | , |
|---|---|
| Formato: | Artículo revista |
| Lenguaje: | Español |
| Publicado: |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2023
|
| Materias: | |
| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/42781 |
| Aporte de: |
| id |
I10-R327-article-42781 |
|---|---|
| record_format |
ojs |
| institution |
Universidad Nacional de Córdoba |
| institution_str |
I-10 |
| repository_str |
R-327 |
| container_title_str |
Revista de la Facultad de Ciencias Médicas de Córdoba |
| language |
Español |
| format |
Artículo revista |
| topic |
colecistectomía laparoscópica vías biliares colangiografía |
| spellingShingle |
colecistectomía laparoscópica vías biliares colangiografía Garcias, L Gramática, L Surgical injury of the bile ducts in residents. Experience of a university training center |
| topic_facet |
colecistectomía laparoscópica vías biliares colangiografía |
| author |
Garcias, L Gramática, L |
| author_facet |
Garcias, L Gramática, L |
| author_sort |
Garcias, L |
| title |
Surgical injury of the bile ducts in residents. Experience of a university training center |
| title_short |
Surgical injury of the bile ducts in residents. Experience of a university training center |
| title_full |
Surgical injury of the bile ducts in residents. Experience of a university training center |
| title_fullStr |
Surgical injury of the bile ducts in residents. Experience of a university training center |
| title_full_unstemmed |
Surgical injury of the bile ducts in residents. Experience of a university training center |
| title_sort |
surgical injury of the bile ducts in residents. experience of a university training center |
| description |
Bile duct surgical injury (LQVB) is a dangerous complication of cholecystectomy, with significant postoperative sequelae. These have an estimated laparoscopic incidence of 0.4% to 1.5%. The aim of this study was to evaluate the incidence of LQVB during the training of the surgeon and the impact on morbidity and mortality with respect to the moment of its diagnosis.
A retrospective observational study of cholecystectomies was conducted by surgeons in training during January 2019 to March 2023.
420 cholecystectomies were analyzed. We recorded three cases of biliary tract surgical lesion (0.71%), where the diagnosis by intraoperative cholangiography (IOC) was in two cases and these patients in 3-year follow-up develop daily life. Presenting a mortality of 33.3% and this case was performed late detection of the injury.
Other autors have reported that patients with LQVB have a significantly lower overall 1-year survival than patients without lesions and patients with late-detection lesions have almost twice the risk of mortality compared to patients with had no injuries. Others, however, did not observe differences in 1-year survival rates in patients with intraoperative LQVB compared to those without LQVB. There are certain tools for reducing LQVB rates, such as CIO, critical safety vision, and subtotal cholecystectomy. The CIO allows us to recognize the biliary anatomy, detect an injury and often reduce the degree of it. In case of intraoperative detection, it allows the possibility to resolve the lesion in a surgical time, or to call a surgeon with more experience, or in cases of not having the hospital structure for the perioperative management of major abdominal surgery, allows to place drains and refer to a reference center. LQVB is a serious complication. In many cases, it is difficult to avoid this complication, but early detection is essential. This is why the systematization of the CIO during surgeon training is irreplaceable. |
| publisher |
Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología |
| publishDate |
2023 |
| url |
https://revistas.unc.edu.ar/index.php/med/article/view/42781 |
| work_keys_str_mv |
AT garciasl surgicalinjuryofthebileductsinresidentsexperienceofauniversitytrainingcenter AT gramatical surgicalinjuryofthebileductsinresidentsexperienceofauniversitytrainingcenter AT garciasl lesionquirurgicadelaviabiliarenresidentesexperienciadeuncentroformadoruniversitario AT gramatical lesionquirurgicadelaviabiliarenresidentesexperienciadeuncentroformadoruniversitario |
| first_indexed |
2024-09-03T21:04:59Z |
| last_indexed |
2024-09-03T21:04:59Z |
| _version_ |
1809210408632844288 |
| spelling |
I10-R327-article-427812023-10-19T21:19:14Z Surgical injury of the bile ducts in residents. Experience of a university training center Lesión quirúrgica de la vía biliar en residentes. Experiencia de un centro formador universitario Garcias, L Gramática, L colecistectomía laparoscópica vías biliares colangiografía Bile duct surgical injury (LQVB) is a dangerous complication of cholecystectomy, with significant postoperative sequelae. These have an estimated laparoscopic incidence of 0.4% to 1.5%. The aim of this study was to evaluate the incidence of LQVB during the training of the surgeon and the impact on morbidity and mortality with respect to the moment of its diagnosis. A retrospective observational study of cholecystectomies was conducted by surgeons in training during January 2019 to March 2023. 420 cholecystectomies were analyzed. We recorded three cases of biliary tract surgical lesion (0.71%), where the diagnosis by intraoperative cholangiography (IOC) was in two cases and these patients in 3-year follow-up develop daily life. Presenting a mortality of 33.3% and this case was performed late detection of the injury. Other autors have reported that patients with LQVB have a significantly lower overall 1-year survival than patients without lesions and patients with late-detection lesions have almost twice the risk of mortality compared to patients with had no injuries. Others, however, did not observe differences in 1-year survival rates in patients with intraoperative LQVB compared to those without LQVB. There are certain tools for reducing LQVB rates, such as CIO, critical safety vision, and subtotal cholecystectomy. The CIO allows us to recognize the biliary anatomy, detect an injury and often reduce the degree of it. In case of intraoperative detection, it allows the possibility to resolve the lesion in a surgical time, or to call a surgeon with more experience, or in cases of not having the hospital structure for the perioperative management of major abdominal surgery, allows to place drains and refer to a reference center. LQVB is a serious complication. In many cases, it is difficult to avoid this complication, but early detection is essential. This is why the systematization of the CIO during surgeon training is irreplaceable. La lesión quirúrgica de la vía biliar (LQVB) es una complicación peligrosa de la colecistectomía, con importantes secuelas postoperatorias. Estas tienen una incidencia estimada por laparoscopía de 0,4 al 1,5%. El objetivo de este estudio es evaluar la incidencia de LQVB durante la formación del cirujano y el impacto en morbimortalidad con respecto al momento del diagnóstico de la misma. Se desarrolló un estudio retrospectivo observacional de colecistectomías realizadas por cirujanos en formación durante enero del 2019 a marzo de 2023. Se analizaron 420 colecistectomías. Registramos tres casos de lesión quirúrgica de la vía biliar (0.71%), donde el diagnóstico mediante colangiografía intraoperatoria (CIO) fue en dos casos y estos pacientes en seguimiento a 3 años desarrollan vida cotidiana. Presentando una mortalidad del 33.3% y este casos se relacionó a detección tardía de la injuria. Algunos autores han reportado que los pacientes con LQVB tienen una supervivencia general a 1 año significativamente menor que los pacientes sin lesiones y los pacientes que tenían lesiones con detección tardía tienen casi el doble de riesgo de mortalidad en comparación con los pacientes que no tenían lesiones. Otros autores, sin embargo, no observaron diferencias en las tasas de supervivencia de 1 año en pacientes con LQVB detectadas en el intraoperatorio en comparación con aquellos sin LQVB. Existen ciertas herramientas para reducción de las tasas de LQVB, como ser la CIO, la visión crítica de seguridad y la colecistectomía subtotal. La CIO nos permite reconocer la anatomía biliar, detectar una injuria y muchas veces reducir el grado de esta. En caso de detección intraoperatoria otorga la posibilidad de resolver la lesión en un tiempo quirúrgico, o poder llamar a un cirujano con mayor experiencia, o en los casos de no contar con la estructura hospitalaria para el manejo perioperatorio de una cirugía abdominal mayor, permite colocar drenajes y derivar a un centro de referencia. La LQVB es una complicación grave. En muchos casos, es difícil poder evitar esta complicación, pero lo imprescindible es detectarlade manera precoz. Es por ello por lo que la sistematización de la CIO durante la formación de cirujano es insustituible. Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología 2023-10-19 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/med/article/view/42781 Revista de la Facultad de Ciencias Médicas de Córdoba.; Vol. 80 (2023): Suplemento JIC XXIV Revista de la Facultad de Ciencias Médicas de Córdoba; Vol. 80 (2023): Suplemento JIC XXIV Revista da Faculdade de Ciências Médicas de Córdoba; v. 80 (2023): Suplemento JIC XXIV 1853-0605 0014-6722 spa https://revistas.unc.edu.ar/index.php/med/article/view/42781/42816 Derechos de autor 2023 Universidad Nacional de Córdoba http://creativecommons.org/licenses/by-nc/4.0 |