Rev Med UAS; Vol. 10: No. 2. Abril-Junio 2020
ISSN 2007-8013


Complicaciones pulmonares en el postoperatorio inmediato de colecistectomía laparoscópica electiva

Pulmonary complications in the immediate postoperative period of elective laparoscopic cholecystectomy

Martín Adrián Bolívar-Rodríguez1*, Pedro Alejandro Magaña-Zavala1, Marcel Antonio Cázarez-Aguilar1, Adrián Pamanes-Lozano1, Oscar Abelardo Murúa-Millán2, Felipe de Jesús Peraza-Garay3.

  1. Servicio de Cirugía General del Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Sinaloa, México.
  2. Servicio de Radiología e Imagen del Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Sinaloa, México.
  3. Departamento de Estadística del Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México.

*Correspondencia: Dr. Martín Adrián Bolívar-Rodríguez
Domicilio: Calle Eustaquio Buelna No. 91, Colonia Gabriel Leyva C.P. 80030, Culiacán, Sinaloa
Tel. (667) 7132606. Correo: bolivarmartin64@hotmail.com

DOI http://dx.doi.org/10.28960/revmeduas.2007-8013.v10.n2.004

Recibido 09 de Mayo 2020, aceptado 24 de Mayo 2020


RESUMEN
Objetivo: Determinar las complicaciones pulmonares producidas en el postoperatorio inmediato de la colecistectomía laparoscópica electiva sin eventualidades. --- Material y métodos: Se realizó un estudio prospectivo, descriptivo, analítico, transversal y observacional, durante el primero de septiembre de 2017 al 30 de septiembre de 2018, de pacientes sometidos a colecistectomía laparoscópica electiva con monitorización en el postoperatorio inmediato, realizando tomografía simple de tórax a 24 horas de realizado el evento quirúrgico. --- Resultados: Se incluyeron 139 pacientes, ninguno desarrolló complicación pulmonar postoperatoria. dieciocho (12.9%) pacientes asintomáticos presentaron alteraciones pulmonares en tomografía de tórax, correspondientes a atelectasias lineales asociadas estadísticamente al tiempo de cirugía, índice de masa corporal y neumoperitoneo. --- Conclusiones: La colecistectomía laparoscópica electiva no complicada en pacientes sin obesidad ni comorbilidades presenta un riesgo nulo de desarrollar complicaciones pulmonares.
Palabras clave: Complicaciones pulmonares postoperatorias, atelectasias, colecistectomía laparoscópica.

ABSTRACT
Objective: To determine the pulmonary complications produced in the immediate postoperative period by elective laparoscopic cholecystectomy without eventualities. --- Material and methods: A prospective, descriptive, analytical, cross-sectional and observational study was conducted, from September 1, 2017 to September 30, 2018, in patients underwent to elective laparoscopic cholecystectomy with immediate postoperative monitoring, performing a simple thorax tomography 24 hours after the surgical event. --- Results: 139 patients were included, none of them developed postoperative pulmonary complication. Eighteen (12.9%) asymptomatic patients presented pulmonary abnormalities on thorax tomography, corresponding to laminar atelectasis, statistically associated with surgical time, body mass index and pneumoperitoneum. --- Conclusions: Elective laparoscopic cholecystectomy without eventualities in patients without obesity or comorbidities presents a null risk of developing pulmonary complications postoperatory.
Key words: Postoperative pulmonary complications, atelectasis, laparoscopic cholecystectomy


Referencias

  1. Restrepo RD, Braverman J. Current challenges in the recognition, prevention and treatment of perioperative pulmonary atelectasis. Expert Rev Respir Med 2015;9(1):97-107.
  2. Abbott TEF, Fowler AJ, Pelosi P, Gama de Abreu M, Moller AM, Canet J, et al. A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. Br J Anaesth. 2018;120(5):1066-79
  3. Tanaja J, Meer JM. Cholelithiasis. [Updated 2017 Nov 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470440/
  4. Enríquez-Sánchez LB, García-Salas JD, Carrillo-Gorena J. Colecistitis crónica y aguda, revisión y situación actual en nuestro entorno. Cir Gen 2018;40(3):175-178.
  5. Ladha K, Vidal Melo MF, McLean DJ, Wanderer JP, Grabitz SD, Kurth T, et al. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospi;tal based registry study. BMJ 2015;351:h3646.
  6. Güldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology 2015;123(3):692-713.
  7. Miskovic A, Lumb AB. Postoperative pulmonary complications. BJA 2017;118(3):317-334.
  8. Fernandez-Bustamante A, Frendl G, Sprung J, Kor DJ, Subramaniam B, Martinez Ruiz R, et al. Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2017;152(2):157-166.
  9. do Nascimento Junior P, Módolo NS, Andrade S, Guimarães MM, Braz LG, El Dib R. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev 2014;2:CD006058.
  10. Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P, et al. Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol 2015;32(2):88-105.
  11. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, et al. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012;307(23):2526-2533.
  12. Beecher HK. Effect of laparotomy on lung volume. Demonstration of new type of pulmonary collapse. J Clin Invest 1933;12(4):651-658.
  13. Hamilton WK. Atelectasis, pneumothorax and aspiration as postoperative complications. Anesthesiology 1961;22:708-722.
  14. Camishion RC. Postoperative atelectasis. Am J Cardiol 1963;12(4): 458-460.
  15. Hua J, Gong J, Yao L, Zhou B, Song Z. Low-pressure versus standard-pressure pneumoperitoneum for laparoscopic cholecystectomy: a systematic review and meta-analysis. Am J Surg. 2014;208(1):143-150.
  16. Yang D, Grant MC, Stone A, Wu CL, Wick EC. A Meta-analysis of Intraoperative Ventilation Strategies to Prevent Pulmonary Complications: Is Low Tidal Volume Alone Sufficient to Protect Healthy Lungs? Ann Surg. 2016;263(5):881-887.
  17. Ozturk K, Soylu E, Topal U. Linear Atelectasis around the Hilum on Chest Radiography: A Novel Sign of Early Lung Cancer. J Clin Imaging Sci 2018;8:27
  18. 18. Mullet R, Jain A, Kotugodella S, Curtis J. Lobar collapse demystified: the chest radiograph with CT correlation. Postgrad Med J 2012;88(1040):335-347.
  19. Rama-Maceiras P. Atelectasias perioperatorias y maniobras de reclutamiento alveolar. Arch Bronconeumol. 2010;46(6):317-324.
  20. D’Antini, Rauseo M, Grasso S, Mirabella L, Camporota L, Cotoia A, et al. Physiological effects of the open lung approach during laparoscopic cholecystectomy: focus on driving pressure. Minerva Anestesiol. 2018;84(2):159-167.
  21. Gurusamy KS, Samraj K, Davidson BR. Low pressure pneumoperitoneum in laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2009;15(2):CD006930