Cirugía de Rescate, Una Opción Eficaz Para Colecistectomía Laparoscópica Difícil

Cohort Study: Rescue surgery, an effective option for difficult laparoscopic cholecystectomy BACKGROUND: The standard treatment for acute cholecystitis is laparoscopic cholecystectomy. Standard laparoscopic cholecystectomy requires the dissection of Calot’s triangle and exposure of the cystic duct; this procedure is associated with bile duct injury and bleeding from the liver vascular bed. Laparoscopic subtotal cholecystectomy could be an alternative in these situations, since it is considered as a procedure associated with few complications. METHODS: A prospective cohort study was conducted. The universe included 180 patients in whom a difficult cholecystectomy was performed; the same was defined as: empyema, gangrene, perforation, severe inflammation with fibrosis, Mirizzi syndrome, vesicular plastron, liver cirrhosis and anatomical variants. It was classified into two groups; Group 1 (traditional cholecystectomy, 90 patients), and Group 2 (rescue cholecystectomy, 90 patients), group 2 used rescue techniques such as: Pribram, subtotal reconstructive, fenestrative and retrograde dissection. The presence of complications (bile duct injury, bleeding, collections and residual choledocholithiasis, infection of the surgical site) was considered as an event. The softwares SPSS 22.0 and Epidat 3.1 were used for the statistical analysis. RESULTS: It was observed that the general incidence of complications in patients with difficult cholecystectomy was 9.44%, the incidence of complications in exposed patients (traditional cholecystectomy) was 14.44%, versus an incidence in unexposed patients (salvage cholecystectomy). 4.44%; RR 3.25 (95% CI: 1.02 - 9.58), p= 0.04. The following techniques were used: retrograde chole-cystectomy 63.33% (n=57), modified Pribram cholecystectomy 21.1% (n=19), reconstructive subtotal 14.44% (n=13), and fenestrative subtotal 0.9 % (n=1). CONCLUSION: Rescue cholecystectomy in difficult cholecystectomy is effective to reduce the risk of complications such as bleeding and bile duct injury; there was no difference between the frequencies of residual choledocholithiasis between the two groups.