Lesões iatrogênicas das vias biliares: diagnóstico e manejo
DOI:
https://doi.org/10.11606/issn.1679-9836.v102i2e-196909Palavras-chave:
Ductos biliares, Colecistectomia, Cirurgia geralResumo
A lesão iatrogênica das vias biliares (LIVB) se configura em uma grave complicação relacionada a abordagens cirúrgicas do trato gastrointestinal e mesmo em centros de referência taxas de 0,2% a 1,5% ainda são registradas. A taxa de LIVB varia se a cirurgia inicial foi realizada por meio de técnica aberta ou videolaparoscópica, e a sua gravidade se dá pelo grande espectro de complicações que podem ser causadas e que apresentam forte impacto negativo na qualidade de vida do paciente. A primeira classificação de LIVB se deu em 1982 com Bismuth e, com o advento da videolaparoscopia, várias outras foram feitas, sendo a de Strasberg uma das mais utilizadas até hoje. A suspeição diagnóstica pode ser feita com auxílio de exames laboratoriais e principalmente com exames de imagem, como a colangiorressonância. O tratamento se constitui em um verdadeiro desafio para a equipe cirúrgica e pode ser realizado por meio de técnicas percutâneas endoscópicas e também cirúrgicas, sendo mais comumente realizada por meio de hepaticojejunostomia em Y de Roux. No paciente com doença hepática em estágio terminal por cirrose biliar secundária, pode ser realizado o transplante hepático. O paciente sempre que possível deve ser acompanhado por uma equipe multidisciplinar e é de suma importância que seja rapidamente encaminhado para um centro especializado.
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