Colangiografia peroperatória sistemática em colecistectomia videolaparoscópica

Surgical infection in a videolaparoscopic cholecystectomy when using peracetic acid for the sterilization of instruments

OBJECTIVE

To determine the frequency of surgical site infection in patients undergoing laparoscopic cholecystectomy with instruments sterilized by peracetic acid.

METHODS

We conducted a retrospective, cohort, descriptive, cross-sectional study. Peracetic acid has been used for sterilization following the protocol recommended by the manufacturer. We observed the criteria and indicators of process and structure for preventing surgical site infection pre and intraoperatively. For epidemiological surveillance, outpatient visits were scheduled for the 15th and between the 30th and 45th days after discharge.

RESULTS

Among the 247 patients, there were two cases of surgical site infection (0.8%). One patient was readmitted to systemic antibiotic therapy and percutaneous puncture; in the other the infection was superficial and followed at the clinic.

CONCLUSION

Ethical issues prevent the conduction of a prospective study because of peracetic acid have been banned for the sterilization of instruments that penetrate organs and cavities. Nevertheless, these results encourage prospective case-control studies comparing its use (historical control) with ethylene oxide sterilization.

Assessment of positive perioperative cholangiography in patients undergoing elective laparoscopic cholecystectomy

OBJECTIVE

To evaluate the positivity of cholangiography in patients without formal indication of this exam undergoing elective cholecystectomy.

METHODS

We included, in the study, 100 patients whose clinical, laboratory and imaging not older than 10 days before the operation showed no change and therefore kept us unsuspicious of choledocholithiasis. The cholangiographies were analyzed and examined by the surgical team, the radiologist and the authors. The reports were compared and correlated with patients' previous clinical and laboratory findings.

RESULTS

The incidence of preoperatively unsuspected choledocholithiasis was only one case (1%).

CONCLUSION

The use of selective cholangiography is safe and should be used in the treatment of calculous cholecystitis.

Complicações da cirurgia videolaparoscópica no tratamento de doenças da vesícula e vias biliares

RACIONAL: O tratamento de escolha para as doenças da vesícula biliar é a colecistectomia, cujo objetivo é o alívio de sintomas e o tratamento e/ou prevenção das complicações. OBJETIVO: Identificar as principais complicações da cirurgia videolaparoscópica no tratamento das doenças da vesícula biliar e vias biliares. MÉTODO: Realizou-se busca eletrônica na base de dados LILACS e Medline desde o ano de 1981 a agosto de 2007; foram encontrados 57 artigos, sendo utilizados para o estudo 31 e três capítulos de livros. RESULTADOS: A produção científica submetida à análise de conteúdo evidenciou os seguintes núcleos temáticos: variações anatômicas (3 artigos), iatrogenias (5 artigos), síndrome pós-colecistectomia (1 artigo), complicações raras (3 artigos), síndrome de Mirizzi (1 artigo), complicações pulmonares (2 artigos) e tratamento (1 capítulo de livro e três artigos). CONCLUSÕES: As complicações que podem ocorrer na cirurgia videolaparoscópica da vesícula biliar e das vias biliares têm basicamente duas vertentes: uma é a inexperiência dos cirurgiões com o método laparoscópico (curva de aprendizado) e outra, as variações anatômicas com as quais os cirurgiões, mesmo os mais experientes, podem se deparar.