Almada, Mario

Pouy, Andrés

Sánchez, Lianet

Revista Peruana de Investigación en Salud

English

Revistas de Investigación UNHEVAL (Universidad Nacional Hermilio Valdizán de Huánuco)

Authors' contributionAll authors participated in the entire research process.Interest conflictWe declare that we have no conflict of interest.Financing sourcesThe study was self-financed.Anatomical variant of the risk bile duct during laparoscopic cholecystectomyVariante anatómica de la vía biliar de riesgo durante la colecistectomía laparoscópica1, 1,cMario Almada a 1,b, Lianet Sánchez ,  Andrés Pouy1Hospital de Clínicas. Dr. Manuel Quintela. Montevideo. Uruguay. Clínica Quirúrgica “B”. Prof. César Canessa. Universidad de la RepúblicaORCID:ahttps://orcid.org/0000-0002-4655-2789bhttps://orcid.org/0000-0003-2132-682Xchttps://orcid.org/0000- 0002-7136-144XCorresponding author:Mario AlmadaPostal Address: Montevideo, UruguayEmail: myalmada111@gmail.comReception date: february 22, 2021Approval date: may 26, 2021Quote as: Almada M, Sánchez L, Pouy A. Variante anatómica de la vía biliar de riesgo durante la colecistectomía laparoscópica. Rev. Peru. Investig. Salud. [Internet]; 5(3): 231-232. Available from: http://revistas.unheval.edu.pe/index.php/repis/article/view/9492616-6097/©2021. Peruvian Journal of Health Research. This is an Open Access article under the CC-BYlicense (https://creativecommons.org/licenses/by/4.0). It allows copying and redistributing the material in any medium or format. You must give credit appropriately, provide a link to the license, and indicate if changes have been made.Surgical injuries to the bile duct were increased in the era of laparoscopic cholecystectomy. The anatomical variants of the bile duct, mainly type F, are predisposing to suffer these serious complications. Performing an intraoperative cholangiography can help prevent these types of complications, which is why many authors recommend its systematic use.The Blumgart classification divides them into A, B, C1, C2, D1, D2, E1, E2 and F (1). The latter is the one that presents the greatest possibility of being injured during a cholecystectomy and is recognized by the mouth of the right posterior sectorial duct at the level of the cystic duct (2).It has a frequency of about 1%. The case presented belongs to a young patient coordinated for laparoscopic cholecystectomy in which intraoperative cholangiography was performed, highlighting the finding of the F-type anatomical variant (Figure 1). One of the technical aspects described to minimize the possibility of surgical injury to the bile duct is to obtain the critical vision of Strasberg (3) (Figure 2). Surgeons must know these anatomical variants in order to avoid bile duct injuries.REVISTA PERUANA DE INVESTIGACIÓN EN SALUDIMAGES IN MEDICINEhttp://revistas.unheval.edu.pe/index.php/repis/https://doi.org/10.35839/repis.5.3.949231ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(3), july - september: 231-232Figure 1. Intraoperative cholangiography showing the anatomical variant of the F-type bile duct of the Blumgart classification. Right posterior sectorial duct leading to the cystic duct (green arrow).Figure 2. Critical view of Strasberg, identifying cystic duct (green arrow) and cystic artery (light blue arrow) prior to clipping of the structures.Surgery for recurrence of vulvar cancer and immediate reconstruction with pudendal fasciocutaneous flapCirugía de recidiva de cáncer de vulva y reconstrucción inmediata con colgajo fasciocutáneo del pudendo1, 1,&Javier Garví-Morcillo %,a 1,&, María SanNicolas-Griñan ,  María I. Sánchez-Zapata1Hospital General Universitario Santa Lucía, Cartegena, España%Resident Intern Physician of Obstetrics and Gynecology&Associate Physician of Obstetrics and GynecologyORCID:ahttps://orcid.org/0000-0002-8827-836XCorresponding author:Javier Garví MorcilloPostal Address: Gynecology and Obstetrics Service, Santa Lucía University Hospital.Minarete Street, s/n, 30202 Cartagena, Murcia, España.Email: garvimorcillojavier@gmail.comReception date: march 08, 2021Approval date: may 30, 2021Quote as: Garví-Morcillo J, SanNicolas-Griñan M,  Sánchez-Zapata MI. Cirugía de recidiva de cáncer de vulva y reconstrucción inmediata con colgajo fasciocutáneo del pudendo. Rev. Peru. Investig. Salud. [Internet]; 5(3): 233-234. Available from: http://revistas.unheval.edu.pe/index.php/repis/article/view/9702616-6097/©2021. Peruvian Journal of Health Research. This is an Open Access article under the CC-BYlicense (https://creativecommons.org/licenses/by/4.0). It allows copying and redistributing the material in any medium or format. You must give credit appropriately, provide a link to the license, and indicate if changes have been made.A 82-year-old woman operated on 15 years ago for squamous cell carcinoma of the vulva. A simple vulvectomy plus bilateral inguinal lymphadenectomy was performed (1 of 7 lymph nodes affected on the left and right side, free of lesion), thus it is stage as a FIGO IIIA (1). Subsequently, adjuvant radiotherapy was applied. After seven years free of disease, the patient decided not to continue the oncological controls. She was referred again to gynecology consultations due to vaginal bleeding. In the anamnesis, he refers to presenting lesions on the vulva for a year and the exploration shows the scar from the previous surgery and an ulcerated lesion that affects the upper third of both labia majora and the central area in contact with the urethra (Image 1).A PET-CT and an MRI of the pelvis were requested, which reported tumor recurrence in the vulvectomy bed, with no evidence of lymph node or distant spread. Through multidisciplinary management, joint surgery was decided between oncological gynecology, urology and plastic surgery, with wide resection of the vulvar lesion and the distal third of the urethra (Image 2), and immediate reconstruction using a fasciocutaneous flap of the pudendal (Image 3). The pathological report reported a well-differentiated and infiltrating Squamous Cell Carcinoma with free surgical margins.REVISTA PERUANA DE INVESTIGACIÓN EN SALUDIMAGES IN MEDICINEhttp://revistas.unheval.edu.pe/index.php/repis/https://doi.org/10.35839/repis.5.3.970233ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(3), july - september: 233-234Figure 1. Ulcerative lesion that affects the upper third of both labia majora and central area in contact with the urethra.Figure 2. Wide resection of the vulvar lesion and the distal third of the urethra.Vulvar cancer, although infrequent (less 1% of gynecological tumors), is a pathology that, due to its extensive surgery and the advanced age of its patients (2), presents a high morbidity and mortality (3). Its insidious symptoms (itching and irritation) cause its diagnosis to be delayed, even in case of recurrence. Most recurrences occur in the first two years after treatment, however, up to 35% have a recurrence at five years or more, thus requiring long-term follow-up (4).Gynecological pathology is forgotten in postmenopausal patients. Its high suspicion is essential for its early diagnosis and thus improve the quality of life of patients. Three months after surgery, our patient continues without signs of recurrence, but with urinary incontinence.References 1. Smadja C, Blumgart LH. The biliary tract and the anatomy of biliary exposure. In Blumgart LH, Ed Surgery of the liver and biliary tract: Churchill Livingstone, Edinburgh, 1988; 1: 11-12.2. Kafle A, Adhikari B, Shrestha R, Ranjit N. Anatomic Variations of the Right Hepatic Duct: Results and Surgical Implications From a Cadaveric Study. J Nepal Health Res Counc. 2019;17(1):90‐93. Published 2019 Apr 28. doi:10.33314/jnhrc.20123. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010 Jul;211(1):132-8. doi: 10.1016/j.jamcollsurg.2010.02.053. Epub 2010 May 26. PMID: 20610259.ISSN 2616 - 6097, Rev Peru Investig Salud, 2021, 5(3), july - september: 231-232232 Almada M, Sánchez L, Pouy A

Variante anatómica de la vía biliar de riesgo durante la colecistectomía laparoscópica

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