Endoscopic and surgical management of iatrogenic biliary tract injuries

BACKGROUND: Iatrogenic biliary tract injury (BTI) is a rare complication but has high risks of morbidity and mortality when it is not early noticed. Although the treatment varies depending on the size of injury and the time until the injury is noticed, endoscopic and percutaneous interventions are usually sufficient. However, it should be remembered that these interventions may cause major complications in the following years, such as biliary stricture, recurrent episodes of cholangitis and even cirrhosis. In this paper, we aimed to present our approach to BTI following cholecystectomy and our treatment management in the light of the literature.
METHODS: The medical records of 105 patients who were treated for BTI between January 2015 and July 2019 were evaluated retrospectively. The majority of the patients consisted of the patients who underwent cholecystectomy at an external medical center and were referred to our clinic due to biliary leakage (BL). Patients were grouped according to Strasberg classification determined by the place of leakage.
RESULTS: Among 105 patients included in this study, 55 were male, and 50 were female. Mean age was 55.2 ±16.26 years (range, 21–93 years). According to Strasberg classification, type A, B, C, D and E injuries were detected in 57, 1, 3, 29 and 15 patients, respectively. Eighty-five patients were successfully treated with endoscopic and percutaneous interventions, while 20 patients underwent surgery.
CONCLUSION: In all patients with suspected BTI, a detailed screening and appropriate treatment provide a significant decline in morbidity and mortality. Therefore, early diagnosis is very important for both early and late outcomes.

Ýyatrojenik safra yolu yaralanmalarýnýn endoskopik ve cerrahi yönetimi

AMAÇ: Ýyatrojenik safra yolu yaralanmalarýný, nadir görülen bir komplikasyon olup erken tanýnmadýðýnda yüksek morbidite ve mortaliteye neden olur. Tedavisi, yaralanma boyutu ve yaralanmanýn fark edilmesine dek geçen süreye göre deðiþmekle birlikte, çoðunlukla endoskopik ve perkütan giriþimler yeterli olmaktadýr. Fakat bu tedaviler sonrasýnda ilerleyen yýllarda biliyer striktür, tekrarlayan kolanjit ataklarý ve hatta siroz gibi majör komplikasyonlara neden olabileceði unutulmamalýdýr. Bu yazýmýzda postkolesistektomi biliyer kaçaklara yaklaþýmýmýzý ve literatür eþliðinde tedavi yönetimini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: Ocak 2015–Temmuz 2019 tarihleri arasýnda biliyer kaçak nedeniyle tedavi ettiðimiz 105 hastanýn dosyasý geriye dönük olarak deðerlendirildi. Hastalarýn çoðunluðunu, dýþ merkezde kolesistektomi geçirip, biliyer kaçak saptanmasý üzerine kliniðimize sevk edilenler oluþturmakta idi. Hastalar kaçak yeri ve miktarýna göre belirlenen Strasberg sýnýflandýrmasýna göre gruplandýrýldý.
BULGULAR: Çalýþmaya alýnan 105 hastanýn 55’i erkek, 50’si kadýn olup ortalama yaþ 55.2±16.26 yýl (21–93 yýl) idi. Strasberg sýnýflamasýna göre; 57 hastada tip A, 1 hastada tip B, 3 hastada tip C, 29 hastada tip D ve 15 hastada tip E yaralanma mevcut idi. Seksen beþ hasta endoskopik ve giriþimsel radyolojik yöntemlerle baþarý ile tedavi edilirken, 20 hastaya cerrahi giriþim yapýldý.
TARTIÞMA: Biliyer kaçaktan þüphelenilen her hastada, ayrýntýlý tarama ve uygun tedavi morbidite ve mortalitede önemli bir düþüþ saðlar. Bu sebeple, erken taný hem erken hem de geç dönem sonuçlar açýsýndan çok önemlidir.