Lesiones postquirúrgicas de la vía biliar. Diagnóstico y tratamiento. Revisión bibliográfica

Abstract

Background: Postoperative bile duct injuries constitute a significant challenge in hepatobiliary surgery. They can occur during conventional or laparoscopic cholecystectomy, leading to bile duct obstruction, vascular complications, and sepsis, reducing the patient's life expectancy. Risk factors include age and anatomical variations, with approximately 20% of the lesions being related to vascular injuries of the right hepatic artery. In developed countries, gallbladder stones affect 10-15% of adults and can result in death. These lesions have different classification systems, with the Strasberg-Bismuth classification being the most widely used. In severe cases, liver transplantation may be necessary. Successful treatment requires surgical experience and precise skills.

Objective: To analyze post-surgical biliary tract lesions, their diagnosis, and treatment.

Methodology: A bibliographic review of articles published in scientific databases such as Taylor & Francis, SciELO, PubMed, Web of Science, and Scopus was conducted. Keywords were combined with Boolean operators, and search filters were used along with inclusion and exclusion criteria. The PRISMA method was used to evaluate and select the articles of scientific interest for the study.

Results: The Strasberg-Bismuth classification is utilized to assess the severity of these lesions, with type E lesions being the most prevalent. Endoscopic retrograde cholangiopancreatography is used to diagnose lesions not detected during the surgical procedure, while nuclear magnetic resonance helps identify arterial lesions. For bile duct repair, the Roux-en-Y hepatic-jejunal anastomosis is a preferred approach. Other methods include primary suture, ERCP with stenting, and the Hepp-Couinaud technique. In severe cases, liver transplantation may be considered