Restrospective Analysis of the Patients with Choledochoduodenostomy in Benign and Malignant Distal Choledochal Stenosis

Öz

Objective: The aim of this study was to determine the suitability of the choledochoduodenostomy for treatment of benign and malignant distal common bile duct stenosis and also, to investigate the relationship between preoperative biochemical data and the causes of obstructive jaundice.

Material and Method: Patients with the diagnosis of choledocholithiasis or pancreatic carcinoma who underwent choledochoduodenostomy between 2014-2018 years were included in the study. Patients were divided into two groups according to their preoperative diagnosis: patients diagnosed with choledocholithiasis (KDL group n=29) and patients diagnosed with pancreatic carcinoma (PCA group; n=5). Demographic characteristics and laboratory data of the patients were compared.

Results: No statistically significant difference was found between the groups in terms of age, gender, length of hospital stay, operation and mortality rates (p>0.05). Anastomotic leakage was not observed in both groups. Preoperative measured ALT, GGT, total bilirubin and direct bilirubin levels of patients in the pancreatic carcinoma group were higher than the patients in the KDL group (p<0.05).

Conclusion: This study suggests that preoperative ALP, GGT, total bilirubin and direct bilirubin levels can be used as an adjunctive biomedical marker for prediction of pancreatic cancer in patients for whom choledochoduodenostomy is planned for obstructive jaundice. Despite the disadvantages, choledochoduodenostomy should be a preferable method in the treatment of distal choledochal obstruction when endoscopic methods are inadequate.

Anahtar Kelimeler

• Obstructive jaundice,choledocholithiasis,pancreatic cancer,choledochoduodenostomy

BENİGN VE MALİGN DİSTAL KOLEDOK DARLIKLARINDA KOLEDOKODUODENOSTOMİ YAPILAN HASTALARIN RETROSPEKTİF ANALİZİ

Öz

Amaç: Bu çalışmanın amacı koledokoduodenostomi girişiminin benign ve malign distal koledok darlıklarında kullanım için uygunluğunu belirlemek ve aynı zamanda preoperatif biyokimya verileri ile tıkanma sarılığı sebepleri arasındaki ilişkiyi karşılaştırmaktır.

Gereç ve Yöntem: Koledokolitiyazis veya pankreas karsinomu tanısı bulunan ve 2014-2018 yılları arasında koledokoduodenostomi yapılan hastalar çalışmaya dahil edildi. Hastalar, preoperatif tanılarına göre koledokolitiyazis tanısı konulan hastalar (KDL grubu n=29), pankreas karsinomu tanısı konulan hastalar (PCA grubu; n=5) olmak üzere iki gruba ayrıldı. Hastaların demografik özellikleri ve laboratuvar verileri karşılaştırıldı.

Bulgular: Yaş, cinsiyet, hastanede yatış süresi, operasyona alınma şekli ve ölüm oranları bakımından iki hasta grubu arasında fark saptanmadı (p>0.05). Her iki grupta da anastomoz kaçağı görülmedi. Pankreas karsinomu grubundaki hastaların preoperatif ölçülen ALT, GGT, total bilirubin ve direkt bilirubin düzeyleri, KDL grubundaki hastalardan daha yüksek bulundu (p <0.05)

Sonuç: Bu çalışma verileri tıkanma sarılığı sebebi ile koledokoduodenostomi planlanan hastalarda preoperatif ALP, GGT, total bilirubin ve direkt bilirubin seviyelerinin, altta yatan sebebi pankreas kanseri açısından öngörmede yardımcı bir biyomedikal marker olarak kullanılabilme olasılığını akla getirmektedir. Koledokoduodenostomi, dezavantajlarına rağmen, distal koledok tıkanıklığının tedavisinde endoskopik yöntemlerin yetersiz kaldığı durumlarda tercih edilebilir bir yöntemdir.

Anahtar Kelimeler

• Tıkanma sarılığı,koledokolitiyazis,pankreas kanseri,koledokoduodenostomi

Kaynakça

1. 1. Okamoto H, Miura K, Itakura J, Fujii H. Current assessment of choledochoduodenostomy: 130 consecutive series. Ann R Coll Surg Engl. 2017; 99(7):545-9.
2. 2. Luu C, Lee B, Stabile BE. Choledochoduodenostomy as the biliary enteric bypass of choice for benign and malignant distal common bile duct strictures. Am Surg. 2013;79(10):1054-57.
3. 3. Cotton PB, Geenen JE, Sherman S, Cunningham JT, Howell DA, Carr-Locke DL et al. Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts. Ann Surgery. 1998;227(2):201-4.
4. 4. Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN et al. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointestinal Endoscopy. 1996; 44(6):643-9.
5. 5. Sahiner IT, Kendirci M. Retrospective clinical study of the effects of T-tube placement for bile duct stricture. Med Sci Monit. 2017;23:4328-33.
6. 6. Kneuertz PJ, Cunningham SC, Cameron JL, Torrez S, Tapazoglou N, Herman JM et al. Palliative surgical management of patients with unresectable pancreatic adenocarcinoma: trends and lessons learned from a large, single institution experience. J Gastrointest Surg. 2011;15(11):1917-27.
7. 7. Madden JL, Chun JY, Kandalaft S, Parekh M. Choledochoduodenostomy: an unjustly maligned surgical procedure? Am J Surg. 1970;119(1):45-54.
8. 8. Panis Y, Fagniez PL, Brisset D, Lacaine F, Levard H, Hay JM. Long term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis. The French Association for Surgical Research. Surg Gynecol Obstet. 1993;177(1):33-7.

9. 9. Mezhir JJ, Brennan MF, Baser RE, D’Angelica MI, Fong Y, DeMatteo RP et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13(12):2163-9.
10. 10. Di Fronzo LA, Egrari S, O'connell TX. Choledochoduodenostomy for palliation in unresectable pancreatic cancer. Arch Surg. 1998;133(8):820-5.
11. 11. Escudero-Fabre A, Escallon Jr A, Sack J, Halpern NB, Aldrete JS. Choledochoduodenostomy. Analysis of 71 cases followed for 5 to 15 years. Ann Surg. 1991;213(6):635-42.
12. 12. Parrilla P, Ramirez P, Bueno FS, Perez J, Candel M, Muelas M et al. Long term results of choledochoduodenostomy in the treatment of choledocholithiasis: Assessment of 225 cases. Br J Surg. 1991;78(4):470-2.