Kolesistektomi Sonrası Biliyer Kaçak Gelişen Hastalarda Biliyer Stent ve Nazobiliyer Drenin Karşılaştırılması

Yıl 2023, Cilt: 7 Sayı: 3, 95 - 103, 19.01.2024

Mehmet Raşit Ayte İlhami Yüksel

https://doi.org/10.33716/bmedj.1403519

Öz

Amaç: Kolesistektomi sonrası gelişen biliyer kaçak tedavisinde Endoskopik Retrograd Kolanjiyopankreatografi (ERCP) ile yerleştirilen biliyer stent veya nazobiliyer dren (NBD) tercih edilen prosedürlerdir. Çalışmamızda, biliyer kaçak tespit edilen hastalarda NBD veya biliyer stentin etkinliğini karşılaştırmayı amaçladık.
Materyal ve metod: Postkoleksistektomi safra kaçağı olan 37 hasta çalışmaya dahil edildi. 20 hastaya biliyer stent, 17 hastaya NBD uygulandı. Hastalar; ek işlem gereksinimi, ERCP komplikasyonları, hastanede yatış süresi, toplam takip süresi açısından karşılaştırıldı.
Bulgular: Biliyer stent uygulanan 20 hastanın 11’inde (%55) sistik güdükten, 5’inde (%25) Luschka’dan, 4’ünde(%20) lateral duvardan kaçak vardı. Hastanede yatış süresi 10.5±7 gün iken, toplam takip süreleri 89.9±42.8 gün di. NBD uygulanan 17 hastanın 10’unda (%58.8) sistik güdükten, 4’ünde (%23.5) lutckadan , 2’sinde(%11.7) lateral duvardan, 1’inde (%5.8) sağ segmental duktustan kaçak vardı. Hastanede yatış süresi 11.9±3 gün iken, total takip süreleri 31.5±11.7 gündü. Ayrıca kaçak lokalizasyonuna gore; 1. grupta (Strazberg tip A) hospitalizasyon süresi 9±2.25 gün, toplam takip siresi 54.04±6.72 iken, 2. grupta (Strazberg tip A dışı) hastanede yatış süresi 16.9±2.68 gün, toplam takip süreleri 84±40,15 gündü.
Sonuç: Biliyer stent uygulanan hastalarda, hastanede yatış süresinin daha kısa olduğu ve komplikasyonların daha az geliştiği, tesbit edildi. NBD'li hastalarda toplam takip süreleri daha kısaydı. Ayrıca çalışmamız uygulanacak modalitenin belirlenmesinde kaçak yerinin de göz önüne alınması gerektiğini düşündürmektedir

Anahtar Kelimeler

biliyer kaçak, biliyer stent, kolesistektomi, nazobiliyer dren

Comparison of biliary stent and nasobiliary drain in patients with biliary leak after cholecystectomy

Öz

Objective: Biliary stent or nasobiliary drain (NBD) placed by Endoscopic Retrograde Cholangiopancreatography (ERCP) are the preferred procedures in the treatment of biliary leak that develops after cholecystectomy. In our study, we aimed to compare the effectiveness of NBD or biliary stent in patients with biliary leakage.
Materials and method: 37 patients with postcholecystectomy bile leaks were included in the study. Biliary stent was applied to 20 patients and NBD was applied to 17 patients. Patients; They were compared in terms of need for additional procedures, ERCP complications, hospital stay, and total follow-up time.
Results: Of the 20 patients to whom biliary stent was applied, 11 (55%) had leakage from the cystic duct, 5 (25%) had leakage from the Luschka, and 4 (20%) had leakage from the lateral wall. While the hospitalization time was 10.5±7 days, the total follow-up time was 89.9±42.8 days. Of the 17 patients who underwent NBD, 10 (58.8%) were from the cystic duct, 4 (23.5%) were from the Luschka, 2 (11.7%) were from the lateral wall, and 1 (5.8%) was from the right segmental duct. The hospitalization period was 11.9±3 days and the total follow-up period was 31.5±11.7 days. Additionally, depending on the leak location; In the 1st group (Strasberg type A), the hospitalization time was 9±2.25 days and the total follow-up time was 54.04±6.72 days, while in the 2nd group (non-Strasberg type A), the hospitalization time was 16.9±2.68 days and the total follow-up time was 84±40.15 days.
Conclusion: It was observed that the hospital stay was shorter and complications were less common in patients who received biliary stents total follow-up times were shorter in patients with NBD. Additionally, our study shows that the location of the leak is also important when determining the procedure to be applied

Anahtar Kelimeler

biliary leak, biliary stent, cholecystectomy, nasobilier drain

Kaynakça

• Roslyn JJ, Binns GS, Hughes EF, Saunders-Kirkwood K, Zinner MJ, Cates JA. Open cholecystectomy. A contemporary analysis of 42,474 patients. Ann Surg 1993; 218: 129-137.H.
• MacFadyen BV Jr, Vecchio R, Ricardo AE, Mathis CR. Bile duct injury after laparoscopic cholecystectomy. The United States experience. Surg Endosc 1998; 12: 315-321.
• Catalano, M.F.: Endoscopic therapy of complications following laparoscopic cholecystectomy : How much can we expect? Endoscopy 29: 389- 391, 1997.
• Feliciano DV, Bitondo CG, Burch JM, et al. Management of traumatic injuries to the extrahepatic biliary ducts. Am J Surg 1985; 150: 705–709.
• Lillemoe KD, Martin SA, Cameron JL, et al. Major bile duct injuries during laparoscopic cholecystectomy. Ann Surg 1997; 225: 459–471.
• Ernst O, Sergent G, Mizrahi D, Delemazure O, L’Hermine C. Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage. Radiology 1999; 211: 345-348.
• Browder IW, Dowling JB, Koontz KK, Litwin MS. Early management of operative injuries of the extrahepatic biliary tract. Ann Surg 1987;205:649–658.
• Soper NJ, Flye MW, Brunt LM, Stockmann PT, Sicard GA, Picus D, Edmundowicz SA, Aliperti G. Diagnosis and management of biliary complications of laparoscopic cholecystectomy. Am J Surg 1993;165:663–669.
• Kaffes AJ, Hourigan L, De Luca N, Byth K, Williams SJ, Bourke MJ. Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc 2005;61:269–275.
• Navaneethan U, Jayanthi V. Endoscopic management of biliary leaks. The answer for the future. Minerv Gastroenterol Dietol 2008;54:141–150.
• Spanos CP, Syrakos T. Bile leaks from the duct of Luschka (subvesical duct): A review. Langenbecks Arch Surg 2006; 391:441–447.
• Youngelman DF, Marks JM, Ponsky T, Ponsky JL. Comparison of bile duct pressure following sphincterotomy and endobiliary stenting in a canine model. Surg Endosc 1997; 11:126–128.
• Libby ED, Branch MS, Cotton PB. Cystic duct leak after laparoscopic cholecystectomy despite preoperative sphincterotomy. Gastrointest Endosc 1995;41:511-514.
• Ryan ME, Geenen JE, Lehman GA, Aliperti G, Freeman ML, Silverman WB, et al. Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicenter review. Gastrointest Endosc 1998;47:261-266.