OPTIMIZACIÓN EN LA ESTRATEGIA DIAGNÓSTICA Y TERAPÉUTICA EN EL QUISTE DE COLÉDOCO.

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Bibliographic Details
Title:	OPTIMIZACIÓN EN LA ESTRATEGIA DIAGNÓSTICA Y TERAPÉUTICA EN EL QUISTE DE COLÉDOCO.
Alternate Title:	Optimization in diagnostic and therapeutic strategy of choledochal cyst.
Authors:	Vivas-Colmenares, Grecia Victoria¹ greciavc_10@hotmail.com, Millán-López, Ana¹, De Agustín A., Juan Carlos¹
Source:	Revista Chilena de Cirugia. Jun2015, Vol. 67 Issue 3, p278-284. 7p.
Abstract (English):	Objectives: The choledochal cyst has an incidence of 1 in 100.000-150.000. The purpose of this study was to analyze the variables introduced for the optimization in the diagnosis and treatment of choledochal cyst. Material and Methods: Retrospective study of patients treated in our center by hepatic-jejunostomy and Roux-Y, from September 1988 to November 2012. We analyzed 40 variables including age, symptoms, type of cysts, diagnostic tests, changes in surgical technique, complications and outcomes. Results: Eighteen patients (66.6% female) were grouped according to the age of presentation: Prenatal (< 1 month), Early (1-24), Delayed (> 24 months). The most common symptoms were jaundice and abdominal pain (for early-onset and late-onset respectively). The 83.3% presented choledochal cysts type I, the ultrasound was sufficient for diagnosis in 94.4%. Since 2004 we modified the surgical technique, performing laparoscopic dissection of the bile duct and cyst, adding a mini-laparotomy (3-5 cm) for hepatic-jejunostomy with 40 cm intestinal loop using polypropylene suture. One complication was observed since 2004, one case of partial dehiscence of the anastomosis resolved with conservative treatment and a cholangitis in 1 patient with hepatic and renal polycystic. In 2012, 83.3% are asymptomatic. Conclusions: The diagnostic have been simplified, in more than 90% of cases was done by ultrasound; advances in minimally invasive surgery and creation of descending loop of 40 cm, have helped to improve the prognosis of choledochal cyst. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Objetivos: El quiste de colédoco presenta una incidencia de 1 en 100.000-150.000. El propósito de este estudio fue analizar las variables introducidas para la optimización en el diagnóstico y tratamiento del quiste de colédoco. Material y Métodos: Estudio retrospectivo de pacientes intervenidos en nuestro centro de quiste de colédoco mediante hepático-yeyunostomía en Y de Roux, desde septiembre de 1988 a noviembre de 2012.Se analizan 40 variables incluyendo edad, sintomatología, tipo de quiste, pruebas diagnósticas, cambios en la técnica quirúrgica, complicaciones y evolución. Resultados: 18 pacientes (66,6% mujeres) fueron agrupados de acuerdo a la edad de presentación: Prenatal (< 1 mes); Precoz (1-24 meses); Tardía (> 24 meses). Los síntomas más frecuentes fueron ictericia y dolor abdominal (para los de inicio precoz y tardío respectivamente). El 83,3% presentaban quistes de colédoco tipo I; siendo suficiente la ecografía para el diagnóstico en el 94,4%. A partir de 2004 modificamos la técnica quirúrgica, realizando por vía laparoscópica la disección de la vía biliar y mediante laparotomía mínima (3-5 cm) hepático-yeyunostomía con asa descendente de 40 cm, empleando sutura de polipropileno, observando desde el 2004, sólo 1 dehiscencia parcial de la anastomosis, resuelta con tratamiento conservador y 1 colangitis en paciente con poliquistosis hepática y renal. En el año 2012 el 83,3% están asintomáticos. Conclusiones: El diagnóstico se ha simplificado, en más de 90% de los casos se realiza sólo con ecografía; los avances en cirugía mínimamente invasiva y la creación de asa descendente de 40 cm, han logrado optimizar el pronóstico del quiste de colédoco. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Objectives: The choledochal cyst has an incidence of 1 in 100.000-150.000. The purpose of this study was to analyze the variables introduced for the optimization in the diagnosis and treatment of choledochal cyst. Material and Methods: Retrospective study of patients treated in our center by hepatic-jejunostomy and Roux-Y, from September 1988 to November 2012. We analyzed 40 variables including age, symptoms, type of cysts, diagnostic tests, changes in surgical technique, complications and outcomes. Results: Eighteen patients (66.6% female) were grouped according to the age of presentation: Prenatal (< 1 month), Early (1-24), Delayed (> 24 months). The most common symptoms were jaundice and abdominal pain (for early-onset and late-onset respectively). The 83.3% presented choledochal cysts type I, the ultrasound was sufficient for diagnosis in 94.4%. Since 2004 we modified the surgical technique, performing laparoscopic dissection of the bile duct and cyst, adding a mini-laparotomy (3-5 cm) for hepatic-jejunostomy with 40 cm intestinal loop using polypropylene suture. One complication was observed since 2004, one case of partial dehiscence of the anastomosis resolved with conservative treatment and a cholangitis in 1 patient with hepatic and renal polycystic. In 2012, 83.3% are asymptomatic. Conclusions: The diagnostic have been simplified, in more than 90% of cases was done by ultrasound; advances in minimally invasive surgery and creation of descending loop of 40 cm, have helped to improve the prognosis of choledochal cyst. [ABSTRACT FROM AUTHOR]
ISSN:	03793893
DOI:	10.4067/s0718-40262015000300007