Eduardo Nápoli

Minimally Invasive Management of Acute Biliary Tract Disease during Pregnancy

Background. Acute biliary diseases during pregnancy have been classically managed conservatively. Advances in minimally invasive surgery and the high recurrence rate of symptoms observed changed this management. Methods. This is a prospective observational study. Initial management was medical. Unresponsive patients were treated with minimally invasive techniques including gallbladder percutaneous aspiration or cholecystostomy, endoscopic retrograde cholangiography, and laparoscopic cholecystectomy, depending on the pregnancy trimester and underlying diagnosis. Results. 122 patients were admitted. 69 (56.5%) were unresponsive to medical treatment. Recurrent gallbladder colic was the most frequent indication for minimally invasive intervention, followed by acute cholecystitis, choledocholithiasis, and acute biliary pancreatitis. 8 patients were treated during the first trimester, 54 during the second, and 7 during the last trimester. There was no fetal morbidity or mortality. Maternal morbidity was minor with no mortality. Conclusion. Acute biliary tract diseases during pregnancy may be safely treated with minimally invasive procedures according to the underlying diagnosis and to the trimester of pregnancy.

Laparoscopic Bile Duct Reexploration for Retained Duct Stones

BackgroundFailure of endoscopic sphincterotomy (ES) for retained bile duct stones occurs in 4% to 10% of cases and was traditionally managed with open bile duct reexploration.MethodsThis study uses retrospective analysis of a consecutive series of cases of laparoscopic bile duct reexploration for retained bile duct stones after unsuccessful ES.ResultsThirty-one cases were operated over a 7-year period. Seventy percent had a previous open cholecystectomy. Ten cases were successfully treated with a transcystic approach and 19 with laparoscopic choledochotomy. Two patients were converted to open surgery. Morbidity was 3.22% with no mortality.ConclusionLaparoscopic bile duct reexploration can be safely performed and should be considered as an alternative to open surgery.

Tratamiento de la coledocolitiasis en un tiempo por videolaparoscopia. Análisis de 10 años de experiencia

Resumen Introduccion El manejo de los pacientes con litiasis vesicular y coledociana plantea controversias. El tratamiento en uno o en dos tiempos son las principales opciones. Material y metodo Analisis retrospectivo de la experiencia de 10 anos en el tratamiento en un tiempo de la coledocolitiasis en un centro terciario de alto volumen. Resultados Se trato inicialmente por laparoscopia a 569 pacientes; se resolvieron con un abordaje transcistico 412 (76,3%); mediante coledocotomia laparoscopica, 128 (23,7%) y se convertio a cirugia abierta a 29 (5%). La morbilidad y la mortalidad general fueron del 2,46 y el 0,52%, respectivamente. Conclusiones En centros de alto volumen el tratamiento en un tiempo y por laparoscopia de la coledocolitiasis es factible y seguro, con una alta proporcion de pacientes que solo necesitan de un abordaje transcistico.