Complicações pós-operatórias em colecistectomia videolaparoscópica: fatores de risco e prevenção
DOI:
https://doi.org/10.34119/bjhrv9n1-110Keywords:
colecistectomia videolaparoscópica, complicações pós-operatórias, infecção do sítio cirúrgico, profilaxia antibiótica, prevenção cirúrgicaAbstract
Esta revisão narrativa teve como objetivo analisar as complicações pós-operatórias associadas à colecistectomia videolaparoscópica, identificando os principais fatores de risco e estratégias de prevenção descritas na literatura recente. Foi realizada busca exclusiva na base PubMed, com seleção de ensaios clínicos, revisões sistemáticas, metanálises e estudos observacionais publicados entre 2016 e 2026, totalizando 42 estudos incluídos. As complicações mais frequentes foram infecção do sítio cirúrgico, sangramento, conversão para cirurgia aberta, dor persistente e abscessos relacionados à perda de cálculos. Idade avançada, diabetes, ASA ≥ 3, bile infectada e colecistite aguda figuraram entre os principais fatores de risco. Estratégias preventivas eficazes incluíram o uso seletivo de antibióticos profiláticos, aplicação de drenos sub-hepáticos em casos complexos, manutenção de AAS em pacientes estáveis, técnicas operatórias inovadoras e cuidados adicionais como a aplicação tópica de HOFA. A individualização das condutas, aliada à avaliação pré-operatória criteriosa e ao uso de medidas baseadas em evidências, mostrou-se essencial para a redução de complicações e melhora dos desfechos clínicos.
References
ABDALLA, Mohamed et al. Single-setting ERCP and cholecystectomy improve the rate of surgical site infection. Surg Endosc, v. 31, n. 12, p. 5135-5142, 2017.
BELLÓN, Marta et al. Topical use of hyperoxygenated fatty acids decreases surgical site infection after laparoscopic cholecystectomy. Int J Surg, v. 99, p. 106253, 2022.
CONRAD, Claudius et al. IRCAD recommendation on safe laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci, v. 24, n. 11, p. 603-615, 2017.
ELMUNZER, B. Joseph et al. The Impact of Cholecystectomy After Endoscopic Sphincterotomy for Complicated Gallstone Disease. Am J Gastroenterol, v. 112, n. 10, p. 1596-1602, 2017.
ELY, Sora et al. Modern Elective Laparoscopic Cholecystectomy Carries Extremely Low Postoperative Infection Risk. J Surg Res, v. 246, p. 506-511, 2020.
GAMO, Gustavo de Oliveira et al. Risk Factors for Surgical Wound Infection After Elective Laparoscopic Cholecystectomy. Arq Bras Cir Dig, v. 35, p. e1675, 2022.
HAN, In Woong et al. Effects of Rowachol on prevention of postcholecystectomy pain after laparoscopic cholecystectomy. HPB (Oxford), v. 18, n. 8, p. 664-670, 2016.
KAWAMOTO, Yusuke et al. Effect of antithrombic therapy on bleeding complications in patients receiving emergency cholecystectomy. J Hepatobiliary Pancreat Sci, v. 25, n. 11, p. 518-526, 2018.
LIANG, Bo; DAI, Min; ZOU, Zhenhong. Safety and efficacy of antibiotic prophylaxis in patients undergoing elective laparoscopic cholecystectomy: A systematic review and meta-analysis. J Gastroenterol Hepatol, v. 31, n. 5, p. 921-928, 2016.
MALIK, Neeraj Kumar et al. Antibiotic prophylaxis and surgical site infections; a prospective open label study. Eur J Clin Pharmacol, v. 81, n. 12, p. 1865-1870, 2025.
NASR, Mohamed Mahmood. An Innovative Emergency Laparoscopic Cholecystectomy Technique. J Gastrointest Surg, v. 21, n. 2, p. 302-311, 2017.
NASSAR, Ahmad H M et al. Sub-hepatic drainage and bile duct exploration in high-volume biliary unit. Langenbecks Arch Surg, v. 409, n. 1, p. 271, 2024.
NOOGHABI, Azadeh Jabbari et al. Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article. Surg Laparosc Endosc Percutan Tech, v. 26, n. 3, p. 183-192, 2016.
PESCE, Antonio; RAMÍREZ-GIRALDO, Camilo. Which is the best timing for performing a cholecystectomy after percutaneous cholecystostomy? Surg Endosc, v. 39, n. 1, p. 14-15, 2025.
QANDEEL, Haitham et al. The Rationale of sub-hepatic drainage on a specialist biliary unit: a review of 6140 elective and urgent laparoscopic cholecystectomies and bile duct explorations. Langenbecks Arch Surg, v. 409, n. 1, p. 271, 2024.
SAKAMOTO, Yusuke et al. Safety of elective laparoscopic cholecystectomy in patients with antiplatelet therapy. Asian J Endosc Surg, v. 13, n. 1, p. 33-38, 2020.
SARKUT, Pinar et al. Routine Use of Prophylactic Antibiotics during Laparoscopic Cholecystectomy Does Not Reduce the Risk of Surgical Site Infections. Surg Infect (Larchmt), v. 18, n. 5, p. 603-609, 2017.
SATO, Manabu et al. Risk Factors of Postoperative Complications in Laparoscopic Cholecystectomy for Acute Cholecystitis. JSLS, v. 24, n. 4, p. e2020.00049, 2020.
SHEIKH, Salim et al. Pharmacological evaluation of prophylactic anti-microbial use in laparoscopic cholecystectomy. Eur J Clin Pharmacol, v. 77, n. 7, p. 1011-1016, 2021.
UTSUMI, Masashi et al. Clinical impact of bile culture from gallbladder in patients undergoing laparoscopic cholecystectomy. Surg Today, v. 55, n. 11, p. 1655-1662, 2025.
VACCARI, Samuele et al. Laparoscopic cholecystectomy: which predicting factors of conversion? Minerva Chir, v. 75, n. 3, p. 141-152, 2020.
VAN BRAAK, Willemieke G. et al. Antibiotic prophylaxis for acute cholecystectomy: PEANUTS II. Br J Surg, v. 109, n. 3, p. 267-273, 2022.
VAN DIJK, Aafke H. et al. Efficacy of Antibiotic Agents after Spill of Bile and Gallstones during Laparoscopic Cholecystectomy. Surg Infect (Larchmt), v. 20, n. 4, p. 298-304, 2019.
XU, Duo et al. Shortened preoperative fasting for prevention of complications associated with laparoscopic cholecystectomy: a meta-analysis. J Int Med Res, v. 45, n. 1, p. 22-37, 2017.
YANG, Jia et al. Reduction of risk of infection during elective laparoscopic cholecystectomy using prophylactic antibiotics: a systematic review and meta-analysis. Surg Endosc, v. 35, n. 12, p. 6397-6412, 2021.
