The hepatobiliary channels called "accessories": su significación e importancia quirúrgica

Los canales hepatobiliares llamados "accesorios": su significación e importancia quirúrgica

Delgado, Bolívar - Aguiar, Alberto - Sbárbaro, Orestes

Resumen:

In conjunction with 5 cases of hepatocystic channels, a survey is carried out of the problem posed by the hepato-biliary channels called "accessory". It is poin tedout that such channels are not "accessory", but normal, so far as· their existence is concerned, and abnormal as regards their termination, constituting the only route ofbiliary drainage of a sector or segment, usually of the hepatic right lobe. Surgical procedures are discussed. In 2 of the 5 cases presented, chaimel ligature was performed, with a subhepatic abscess of biliary origin, as a postoperative complication. In other 2 cases, cholecystectomy was done, leaving the cystic stump wherein the -channel ended. In the remaining case, a channel wound developed, which was sutured and calibrated with Kehr's tube. The course of these patients warrants the contention that in cases of anomalouschannels of an appreciable caliber, a conservative approach is in order. Of primary importance is the correct exposure of the pedicular components supplemented, when feasible, by cholangiographic control, befare deciding upon whathatever therapeutic approach.


A propósito de cinco observaciones de canales hepatocísticos, los autores hacen una revisión del problema que plantean los canales hepatobiliares llamados "accesorios".Se insiste en el hecho de que tales canales no son "accesorios", sino canales normales en cuanto a su existencia y Hnómalos en cuanto a su terminación, constituyendola única vía de desagüe biliar de un sector o segmento, habitualmente del lóbulo derecho del hígado. Se analiza la táctica quirúrgica a seguir. De los cinco casos presentados, en dosse realizó la ligadura del canal, lo cual condujo como complicación postoperatoria a un absceso subhepático de origen biliar; en otros dos se efectuó colecistectomía,dejando el muñón del cístico en el cual terminaba el canal; en la quinta observación se produjo una herida del canal que fue suturada y calibrada con tubo de Kehr.La evolución de estas pacientes, lleva a los autores a sostener que se debe actuar en forma conservadora frente a canales anómalos de calibre apreciable. Se considera de fundamental importancia la exposición correcta de los elementos pediculares, complementada, de ser posible, con un control colangiográfico antes de resolver cualquier conducta terapéutica.


Detalles Bibliográficos
2020
cirugía biliar
vías biliares
canales biliares
malformaciones
billiary surgery
bile ducts
malformations
Español
Sociedad de Cirugía del Uruguay
Revista Cirugía del Uruguay
https://revista.scu.org.uy/index.php/cir_urug/article/view/1869
Acceso abierto
Resumen:
Sumario:In conjunction with 5 cases of hepatocystic channels, a survey is carried out of the problem posed by the hepato-biliary channels called "accessory". It is poin tedout that such channels are not "accessory", but normal, so far as· their existence is concerned, and abnormal as regards their termination, constituting the only route ofbiliary drainage of a sector or segment, usually of the hepatic right lobe. Surgical procedures are discussed. In 2 of the 5 cases presented, chaimel ligature was performed, with a subhepatic abscess of biliary origin, as a postoperative complication. In other 2 cases, cholecystectomy was done, leaving the cystic stump wherein the -channel ended. In the remaining case, a channel wound developed, which was sutured and calibrated with Kehr's tube. The course of these patients warrants the contention that in cases of anomalouschannels of an appreciable caliber, a conservative approach is in order. Of primary importance is the correct exposure of the pedicular components supplemented, when feasible, by cholangiographic control, befare deciding upon whathatever therapeutic approach.