Factores asociados a colecistectomía laparoscópica difícil en los Servicios de Cirugía General de los Hospitales del Minsa Cusco 2019

Abstract

Objetivos: Identificar los factores asociados a la colecistectomía laparoscópica difícil en los servicios de Cirugía General de los hospitales del MINSA Cusco 2019. Métodos: Se trata de un estudio de casos y controles, el muestreo fue no probabilístico en la que se seleccionaron 60 casos y 120 controles, en pacientes que fueron intervenidos a colecistectomía laparoscópica en los hospitales MINSA Cusco durante el año 2019. Resultados: Se identificó como factores de riesgo: edad mayor a 55 años OR=2.15 IC95%(1.08–4.31); sexo masculino OR=3.87 IC95%(1.51–9.96); tipo de cirugía por emergencia OR=2.68 IC95%(1.42–5.08); procedencia OR=0.87 IC95%(0.46–1.64); hipertensión arterial OR=5.80, IC95% (1.74–19.37); diabetes mellitus OR=2.51 IC95% (0.84–7.83); enfermedad pulmonar obstructiva OR=0.66 IC95% (0.07–6.49); cirrosis hepática OR=10.82 IC95% (1.23–94.81); pancreatitis OR=0.48, IC95% (0.09–2.35); cirugía abdominal previa OR=2.27 IC95% (1.23–4.57); insuficiencia cardiaca congestiva OR=6.26 IC95% (0.64–61.55); leucocitosis OR=4.35 IC95% (2.05–9.22); bilirrubina elevada OR=0.51 IC95% (0.23–1.12); TGO elevada OR =2.80 IC95% (1.04–7.52), TGP elevada OR=2.42, IC95% (1.28–4.58); grosor de la pared vesicular >4mm OR=3.37 IC95% (1.76–6.42); calculo impactado OR=3.23 IC95% (1.16–8.97); adherencias/dificultad para identificar la anatomía OR=4.67 IC95% (2.21–9.86); Síndrome de Mirizzi OR=6.56 IC95% (1.28–33.54); sospecha de neoplasia maligna de vesícula (P=0.044), vesícula escleroatrofica OR=2.07 IC95% (0.50–8.59); hidrocolecisto OR=3.83 IC95% (1.08–13.65); piocolecisto OR=29.50 IC95% (6.60–131.83); gangrena vesicular OR=3.11 IC95% (2.51–3.85); plastrón vesicular OR=25.29, IC95% (5.63– 113.63); experiencia del médico especialista OR=1.00 IC95% (0.18–5.62). Conclusiones: Se han identificado factores de riesgo epidemiológicos como edad mayor de 55 años, sexo masculino, tipo de cirugía por emergencia, antecedentes de hipertensión arterial, cirrosis hepática y cirugía abdominal previa; laboratoriales como leucocitosis, elevación de TGO y TGP; ecográficos: el aumento del grosor de la pared vesicular más de 4 mm, presencia de cálculo impactado; factores intraoperatorios: presencia de adherencias que dificulten la identificación de la anatomía, síndrome de Mirizzi, Hidrocolecisto, piocolecisto, gangrena vesicular, y plastrón vesicular.

Objectives: To identify the factors associated with difficult laparoscopic cholecystectomy in the General Surgery services of MINSA Cusco 2019 hospitals. Methods: This is a case-control study, the sampling was non-probability in which 60 cases and 120 controls were selected, in patients who underwent laparoscopic cholecystectomy at MINSA Cusco hospitals during 2019. Results: The following were identified as risk factors: age over 55 years OR=2.15 95%CI (1.08–4.31); male sex OR=3.87 95%CI (1.51–9.96); type of emergency surgery OR=2.68 95%CI (1.42–5.08);provenance OR=0.87 95%CI(0.46–1.64); arterial hypertension OR=5.80, 95%CI (1.74–19.37);diabetes mellitus OR=2.51 95%CI (0.84–7.83); obstructive pulmonary disease OR=0.66 95%CI(0.07–6.49); liver cirrhosis OR=10.82 95%CI(1.23–94.81);pancreatitis OR=0.48 95%CI(0.09–2.35);previous abdominal surgery OR=2.27 95%CI(1.23–4.57); congestive heart failure OR=6.26 95%CI(0.64– 61.55); leukocytosis OR=4.35 95%CI (2.05–9.22); elevated bilirubin OR=0.51 95%CI (0.23–1.12); TGO high OR=2.80 95%CI (1.04–7.52), high TGP OR=2.42, 95%CI (1.28– 4.58); gallbladder wall thickness>4mm OR=3.37 95%CI(1.76–6.42);calculation impacted OR=3.23 95%CI(1.16–8.97); adhesions/difficulty in identifying the anatomy OR=4.67 95%CI (2.21–9.86);Mirizzi syndrome OR=6.56 95%CI (1.28–33.54); suspicion of malignancy of the gallbladder(P=0.044), scleroatrophic gallbladder OR=2.07 95%CI(0.50–8.59);hidrocolecisto OR=3.83 95%CI(1.08–13.65); pyocolecisto OR=29.50 95%CI (6.60–131.83);vesicular gangrene OR=3.11 95%CI (2.51–3.85); vesicular plastron OR=25.29 95%CI (5.63–113.63);experience of the specialist OR=1.00 95%CI (0.18–5.62). Conclusions: We identified risk factors such as age over 55 years, male sex, type of emergency surgery, history of hypertension, liver cirrhosis, and previous abdominal surgery; laboratory tests such as leukocytosis, elevation of TGO and TGP; sonographic: the increase in the thickness of the gallbladder wall more than 4 mm, presence of impacted stone; presence of adhesions that hinder the identification of the anatomy, Mirizzi syndrome, hydrocolecisto, pyocolecisto, vesicular gangrene, and vesicular plastron.