|Tipo di tesi||Tesi di laurea magistrale|
|Titolo||Gestione delle complicanze chirurgiche in corso di colecistectomia laparoscopica: dal trattamento endoscopico al trapianto di fegato|
|Titolo in inglese||Management of surgical complications during laparoscopic cholecystectomy: from endoscopic treatment to liver transplant|
|Struttura||Dipartimento di Scienze Biomediche, Metaboliche e Neuroscienze|
|Corso di studi||MEDICINA E CHIRURGIA (D.M.270/04)|
|Data inizio appello||2021-07-14|
|Disponibilità||Accesso limitato: si può decidere quali file della tesi rendere accessibili. Disponibilità mixed (scegli questa opzione se vuoi rendere inaccessibili tutti i file della tesi o parte di essi)|
|Data di rilascio||2061-07-14|
BACKGROUND: Le lesioni del dotto biliare (BDI) in corso di colecistectomia laparoscopica (CL) sono complicanze relativamente rare ma con importanti implicazioni in termini di sopravvivenza e qualità di vita.
BACKGROUND: Bile duct lnjuries (BDI) during laparoscopic cholecystectomy (LC) are not uncommon but above all severe complications with important implications in terms of survival and quality of life. METHODS: We have analyzed data from October 2002 to November 2020 considering patients referred for BDI post LC to the operating unit of Oncological Hepato-bilio-pancreatic Surgery and Liver Transplantation of the University Hospital Modena Policlinico. The analysis has included: data demographics, indications to LC, symptoms presented, timing of referral at the center, type of lesion according to the Hannover classification, type of patient management after being referred to our center, morbidity and mortality. Lesions of the biliary tract after open cholecystectomy were excluded from the study as well as for cholecystectomies performed for cancer, primary liver disease or during non-elective surgery. RESULTS: Eleven patients, with a mean age of 56.9 years (range 22-79) were referred to this center for biliary tract lesions during LC. The clinical presentation was extremely variable. The timing of referral was early in 4 cases, intermediate in 3 cases, and late in 4. According to Hannover classification, the following were diagnosed: 1 injury type B2, 4 injuries type D2, 5 injuries type D3,1 injury type C2. All patients were treated with a surgical approach: 2 liver transplants, 6 hepato-jejunal anastomoses, 1 right hepatectomy with hepatic-jejunal anastomosis and 1 external biliary shunt with revision of the hepatic-jejunal anastomosis. The overall complication rate was 63.63%. The mean overall survival was estimated to be 64.27 ± 94.89 months; no readmissions were observed. CONCLUSIONS: According to the statistical analysis, both interventions performed before referral and later ones negatively impact the outcome after definitive repair. Liver transplantation can be the only viable option in case of serious complications such as liver failure or complex vascular and biliary lesions. Evidence shows that a prompt referral to third level hepatobiliary centers is fundamental in order to significantly reduce the rate of therapeutic failure. The promotion of a "Culture of Safety and an adequate knowledge of different possible scenarios, must constitute the necessary references in order to guarantee a correct therapeutic management and a better quality life for patients.