OriginalHemorragia diferida de la arteria hepática derecha tras iatrogenia biliar por colecistectomía laparoscópica que precisó trasplante hepático por insuficiencia hepática aguda: caso clínico y revisión de la literaturaDelayed right hepatic artery haemorrhage after iatrogenic gallbladder by laparoscopic cholecystectomy that required a liver transplant due to acute liver failure: clinical case and review of the literature
Section snippets
Introducción
Desde la introducción de la colecistectomía laparoscópica (CL) se ha duplicado la incidencia de lesiones iatrogénicas de la vía biliar principal (LIVBP), respecto a la colecistectomía abierta (CA) y suelen ser más complejas (más altas en su localización y con frecuente desaparición de segmentos de vía biliar)1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14. Además, existe un incremento de lesiones vasculares asociadas (entre el 17-40% de LIVBP graves tras CL se asocian a lesiones vasculares),
Revisión bibliográfica
Hemos revisado la literatura médica respecto a la evolución clínica y manejo de lesiones biliares después de CL, asociadas a una lesión de la AHD, AHC o combinadas con lesión de VP. En estos artículos se buscó de forma especial aquellos que describen pacientes con indicación de TH por un FHF, sepsis o CBS, siempre y cuando fuesen secundarios a una lesión biliar y vascular asociadas. Estos artículos se obtuvieron a través del PubMed, empleando como palabras clave: «laparoscopic bile duct injury
Discusión
La incidencia de LIVBP tras CL es casi el doble del observado por CA (0,3-0,6 vs 0,1-0,3%)1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 22, 23, 24, 25, siendo lesiones más complejas (más graves, más altas en su localización y con frecuente desaparición de segmentos biliares). A veces se asocian lesiones vasculares, no conociéndose su incidencia real, aunque existen numerosas publicaciones15, 16, 17, 19, 25, 35, 36, 37 que abogan por un incremento de su incidencia respecto a CA. Deziel et al.35
Conflicto de intereses
Los autores declaran no tener ningún conflicto de intereses
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