Colangiografia transoperatória em colecistectomia laparoscópica

Fontes, Paulo Roberto Ott; Nectoux, Mauro; Eilers, Rene Jacobsen; Chem, Eduardo Mainieri; Reidner, Charles Edison

doi:10.1590/S0100-69911998000600005

Resumos

Com o objetivo de analisar os resultados e a experiência acumulada com a realização de colangiografia transoperatória nos pacientes submetidos à colecistectomia laparoscópica, revisamos os prontuários de 309 pacientes com colelitíase sintomática tratados por videocirurgia no nosso serviço entre maio de 1993 e junho de 1997. Realizamos a colangiografia transoperatória rotineiramente, o que foi possível em 244 (78,9%) pacientes. O principal motivo para a não realização do exame nos demais pacientes foi a presença do ducto cístico de pequeno calibre em 21 (6,8%) casos. Entre os pacientes nos quais foi realizado o exame, o resultado foi normal em 229 (93,8%). Em 11 (4,5%) identificou-se coledocolitíase, sendo insuspeita em sete (2,8%); em três (1,2%), o ducto cístico desembocava no ducto hepático direito, e, em um (0,4%), diagnosticou-se um grande cisto coledociano com calculose intra e extra-hepática. A colangiografia transoperat6ria durante colecistectomia laparoscópica mostrou-se um procedimento seguro nos pacientes em que conseguimos realizá-la, já que não tivemos complicações relacionadas ao exame. Ao definir a anatomia, previne ou demonstra alterações biliares e permite a detecção de coledocolitíase insuspeita. Assim, pelos dados analisados, recomendamos o seu emprego rotineiro.

Laparoscopia; Videolaparoscopia; Colecistectomia; Colecistectomia videolaparoscópica; Colangiografia

With laparoscopic cholecystectomy, the intraoperative cholangiography has been motive of intense controversy. Some authors perform it routinely. They consider laparoscopic cholecystectomy only an alternative to open access and, in that case, must be the same as conventional procedure. On the other hand, many authors believe that few patients have a true indication to evaluate the biliary tree. These authors do selectively intraoperative cholangiography. We performed 309 laparoscopic cholecystectomies between may 1993 and june 1997. The records of these patients were reviewed. Our results and experience with intraoperative cholangiography are evaluated. We usually perform intraoperative cholangiography by cystic duct catheterization, whenever feasible and without risk of injury to the biliary tree. It was possible in 244 (78.9%) cases. The main cause of unsuccessful was the presence of narrow cystic duct and occurred in 21 (6.8%) patients. The exam was normal in 229 (93.8%). Unsuspected choledocholithiasis was detected in six (2.4%), cystic duct draining into right hepatic duct was present in three (J.2%)and one (0.4%) had a choledocal cyst. The intraoperative cholangiography was a safe procedure in our patients who underwent laparoscopic cholecystectomy and, with our results, we recommend your routinely employment.

Laparoscopy; Laparoscopic cholecystectomy; Videolaparoscopy; Cholangiography

ARTIGOS ORIGINAIS

Colangiografia transoperatória em colecistectomia laparoscópica

Intraoperative cholangiography in laparoscopic cholecystectomy

Paulo Roberto Ott Fontes, TCBC-RS^I; Mauro Nectoux^II; Rene Jacobsen Eilers^III; Eduardo Mainieri Chem^IV; Charles Edison Reidner^IV

^IProfessor Livre-Docente em Cirurgia, Chefe do Serviço de Cirurgia Geral da FFFCMPA/ISCMPA, Coordenador do Curso de Pós-Graduação em Clínica Cirúrgica da FFFCMPA/ISCMPA, Chefe da Divisão Cirúrgica do SGCC

^IIMestre em Cirurgia, Membro do SGCC

^IIIMestrando em Cirurgia, Membro do SGCC

^IVResidente do Serviço de Cirurgia

^{Endereço para correspondência} Endereço para correspondência: Dr. Paulo Roberto Ott Fontes Rua General Vitorino, 330/802 90020-170 - Porto Alegre - RS

RESUMO

Com o objetivo de analisar os resultados e a experiência acumulada com a realização de colangiografia transoperatória nos pacientes submetidos à colecistectomia laparoscópica, revisamos os prontuários de 309 pacientes com colelitíase sintomática tratados por videocirurgia no nosso serviço entre maio de 1993 e junho de 1997. Realizamos a colangiografia transoperatória rotineiramente, o que foi possível em 244 (78,9%) pacientes. O principal motivo para a não realização do exame nos demais pacientes foi a presença do ducto cístico de pequeno calibre em 21 (6,8%) casos. Entre os pacientes nos quais foi realizado o exame, o resultado foi normal em 229 (93,8%). Em 11 (4,5%) identificou-se coledocolitíase, sendo insuspeita em sete (2,8%); em três (1,2%), o ducto cístico desembocava no ducto hepático direito, e, em um (0,4%), diagnosticou-se um grande cisto coledociano com calculose intra e extra-hepática. A colangiografia transoperat6ria durante colecistectomia laparoscópica mostrou-se um procedimento seguro nos pacientes em que conseguimos realizá-la, já que não tivemos complicações relacionadas ao exame. Ao definir a anatomia, previne ou demonstra alterações biliares e permite a detecção de coledocolitíase insuspeita. Assim, pelos dados analisados, recomendamos o seu emprego rotineiro.

Unitermos: Laparoscopia; Videolaparoscopia; Colecistectomia; Colecistectomia videolaparoscópica; Colangiografia.

ABSTRACT

With laparoscopic cholecystectomy, the intraoperative cholangiography has been motive of intense controversy. Some authors perform it routinely. They consider laparoscopic cholecystectomy only an alternative to open access and, in that case, must be the same as conventional procedure. On the other hand, many authors believe that few patients have a true indication to evaluate the biliary tree. These authors do selectively intraoperative cholangiography. We performed 309 laparoscopic cholecystectomies between may 1993 and june 1997. The records of these patients were reviewed. Our results and experience with intraoperative cholangiography are evaluated. We usually perform intraoperative cholangiography by cystic duct catheterization, whenever feasible and without risk of injury to the biliary tree. It was possible in 244 (78.9%) cases. The main cause of unsuccessful was the presence of narrow cystic duct and occurred in 21 (6.8%) patients. The exam was normal in 229 (93.8%). Unsuspected choledocholithiasis was detected in six (2.4%), cystic duct draining into right hepatic duct was present in three (J.2%)and one (0.4%) had a choledocal cyst. The intraoperative cholangiography was a safe procedure in our patients who underwent laparoscopic cholecystectomy and, with our results, we recommend your routinely employment.

Key words: Laparoscopy; Laparoscopic cholecystectomy; Videolaparoscopy; Cholangiography.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Recebido em 10/11/97

Aceito para publicação em 3/8/98

Trabalho realizado no Serviço de Gastroenterologia Clínica e Cirúrgica (SGCC) do Complexo Hospitalar da Santa Casa de Porto Alegre e do Departamento de Cirurgia da Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA).

1. Bouillot JL, Femandez FJ, Dehni N, et al. Intraoperative systematic cholangiography in celioscopic cholecystectomy. Gastroenterol Clin Biol 1995,19(3):287-290.
2. Korman J, Cosgrove J, Furman M at al. The role of endoscopic retrograde cholangiopancreatography and cholangiography in the laparoscopic era. Ann Surg 1996,223(2):212-216.
3. Madhavan KK, Macintyre IMC, Wilson RG et al. Role of intraoperative cholangiography in laparoscopic cholecystectomy. Br J Surg 1995, 82:249-252.
4. Robinson BL, Donohue JH, Gunes S at al. Selective operative cholangiography. Appropriate management for laparoscopic cholecystectomy. Arch Surg 1995, 130(6):625-630.
5. Mirizzi PL. La cholangiografla durante las operaciones de las vias biliares. Bol Soc Cir Buenos Aires 1932,16:1133-1135.
6. Woods MS at al. Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc 1995; 9:1076-1080.
7. CarroII BJ, Phillips EH, Rosenthal R, et al. One hundred consecutive laparoscopic cholangiograms - results and conclusions. Surg Endosc 1996; 10:319-323.
8. Greco 1, Gentile A, Testini M, et al. L'impiego selettivo della colangiografia intraoperatoria nella chirurgia della calcolosi biliare. Minerva Gastroenterol Dietol l995; 41:223-226.
9. Clair OG, Brooks OC. Laparoscopic cholangiography. The case for a selective approach. Surg Clin North Am 1994; 74:961-966.
10. Rosenthal RJ, Steigerwald SO, Imig R, et al. Role of intraoperative cholangiography during endoscopic cholecystectomy. Surg Laparosc Endosc 1994; 4:171-174.
11. Fox AD, et al. Peroperative cholangiography through the gallbladder (cholecystocholangiography) during laparoscopic cholecystectomy. Surg Lapar Endosc 1996; 1:22-25.
12. Cahill CJ, Pain JA. Current practice in biliary surgery. Br J Surg 1988; 75:1169-1172.
13. Macintyre IMC, Wilson RG. Impact of laparoscopic cholecystectomy in the UK: a survey of consultants. Br J Surg 1993,80:346-347.
14. Savassi-Rocha PR, Ferreira JT, Diniz MTC. Laparoscopic cholecystectomy in Brazil: analysis of 13514 cases. Arq Bras Cir Dig 1995;10(2):40-46.
15. Caprini JA. Cost-effective laparoscopic cholangiography. Surg Laparosc Endosc 1994; 2:142-145.
16. Soper NJ, Brunf LM. The case for routine operative cholangiography during laparoscopic cholecystectomy. Surg Clin North Am 1994; 74:953-959.
17. Pickuth D, Leutloff U. Selektive intraoperative cholangiographie hei laparoskopischer. Lagenbecks Arch Chir 1995; 380:299-301.
18. Cuschieri A, Shimi S, Banting S, et al. Intraoperative cholangiography during laparoscopic cholecystectomy. routine vs selective policy. Surg Endosc 1994; 8:302-305.

Endereço para correspondência:

Dr. Paulo Roberto Ott Fontes

Rua General Vitorino, 330/802

90020-170 - Porto Alegre - RS

Datas de Publicação

Publicação nesta coleção
31 Maio 2010
Data do Fascículo
Dez 1998

Histórico

Aceito
03 Ago 1998
Recebido
10 Nov 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Bouillot JL, Femandez FJ, Dehni N, et al. Intraoperative systematic cholangiography in celioscopic cholecystectomy. Gastroenterol Clin Biol 1995,19(3):287-290.

[2] 2. Korman J, Cosgrove J, Furman M at al. The role of endoscopic retrograde cholangiopancreatography and cholangiography in the laparoscopic era. Ann Surg 1996,223(2):212-216.

[3] 3. Madhavan KK, Macintyre IMC, Wilson RG et al. Role of intraoperative cholangiography in laparoscopic cholecystectomy. Br J Surg 1995, 82:249-252.

[4] 4. Robinson BL, Donohue JH, Gunes S at al. Selective operative cholangiography. Appropriate management for laparoscopic cholecystectomy. Arch Surg 1995, 130(6):625-630.

[5] 5. Mirizzi PL. La cholangiografla durante las operaciones de las vias biliares. Bol Soc Cir Buenos Aires 1932,16:1133-1135.

[6] 6. Woods MS at al. Biliary tract complications of laparoscopic cholecystectomy are detected more frequently with routine intraoperative cholangiography. Surg Endosc 1995; 9:1076-1080.

[7] 7. CarroII BJ, Phillips EH, Rosenthal R, et al. One hundred consecutive laparoscopic cholangiograms - results and conclusions. Surg Endosc 1996; 10:319-323.

[8] 8. Greco 1, Gentile A, Testini M, et al. L'impiego selettivo della colangiografia intraoperatoria nella chirurgia della calcolosi biliare. Minerva Gastroenterol Dietol l995; 41:223-226.

[9] 9. Clair OG, Brooks OC. Laparoscopic cholangiography. The case for a selective approach. Surg Clin North Am 1994; 74:961-966.

[10] 10. Rosenthal RJ, Steigerwald SO, Imig R, et al. Role of intraoperative cholangiography during endoscopic cholecystectomy. Surg Laparosc Endosc 1994; 4:171-174.

[11] 11. Fox AD, et al. Peroperative cholangiography through the gallbladder (cholecystocholangiography) during laparoscopic cholecystectomy. Surg Lapar Endosc 1996; 1:22-25.

[12] 12. Cahill CJ, Pain JA. Current practice in biliary surgery. Br J Surg 1988; 75:1169-1172.

[13] 13. Macintyre IMC, Wilson RG. Impact of laparoscopic cholecystectomy in the UK: a survey of consultants. Br J Surg 1993,80:346-347.

[14] 14. Savassi-Rocha PR, Ferreira JT, Diniz MTC. Laparoscopic cholecystectomy in Brazil: analysis of 13514 cases. Arq Bras Cir Dig 1995;10(2):40-46.

[15] 15. Caprini JA. Cost-effective laparoscopic cholangiography. Surg Laparosc Endosc 1994; 2:142-145.

[16] 16. Soper NJ, Brunf LM. The case for routine operative cholangiography during laparoscopic cholecystectomy. Surg Clin North Am 1994; 74:953-959.

[17] 17. Pickuth D, Leutloff U. Selektive intraoperative cholangiographie hei laparoskopischer. Lagenbecks Arch Chir 1995; 380:299-301.

[18] 18. Cuschieri A, Shimi S, Banting S, et al. Intraoperative cholangiography during laparoscopic cholecystectomy. routine vs selective policy. Surg Endosc 1994; 8:302-305.

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