Postoperatif safra kaçaðý olan olgularda endoskopik retrograd kolanjiyopankreatografi ile endoskopik sfinkterotomi ve biliyer stentlemenin etkinliði ve güvenliði

AMAÇ: Biz bu çalýþmada, laparoskopik kolesistektomi ve kist hidatik cerrahisi sonrasý görülen safra yolu kaçaðýnýn taný ve tedavisinde, endoskopik retrograd kolanjiopankreatografi (ERCP), sfinkterotomi, balon ile safra yolu taramasý ve plastik stent uygulamasýnýn etkinliðini ve güvenliliðini deðerlendirmeyi amaçladýk.
GEREÇ VE YÖNTEM: Çalýþmada ameliyat sonrasý safra kaçaðý sebebi ile ERCP, sfinkterotomi, stent iþlemi yapýlan hastalar deðerlendirildi. Hastalar ERCP iþleminde saptanan safra kaçaðý yerine göre 4 grup altýnda (sistik kanal güdüðü, kese yataðý, kist hidatik içi, koledok) toplandý. ERCP iþlemi sonrasý iþlem baþarýsý, dren çekim süresi, ERCP iþlemine baðlý, kanama, pankreatit ve perforasyon gibi erken komplikasyon geliþip, geliþmediði, ERCP de obstrüktif patoloji varlýðý açýsýndan deðerlendirildi.
BULGULAR: Baþarýlý ERCP iþlemi yapýlan 65/73 hastada (%89) klinik iyileþme saptandý ve drenleri çekilebildi. Ortalama dren çekme süresi 32.69±23.32 gün saptandý. Laparoskopik kolesistektomi sonrasý safra kaçaðýnýn en sýk sistik kanal güdüðünden olduðu görüldü. Gruplar arasýnda iþlem baþarý oranlarý açýsýndan fark saptanmadý. Sistik kanaldan kaçak olan hasta grubunda dren çekim süresinin diðer 3 gruba göre daha kýsa olduðu görüldü (p<0.05). ERCP iþlemi sonrasý 5/73 (%6.9) hastada medikal tedavi ile düzelen, minör ERCP komplikasyonu izlendi. Major ERCP komplikasyonu görülmedi. Ayrýca, 25/73 hastada (%34.2) safra yolunda taþ ve kist hidatik membraný gibi obstrüktif bir patoloji saptandý.
TARTIÞMA: Laparoskopik kolesitektomi ve kist hidatik cerrahisine baðlý biliyer kaçak hastalarýnda, ERCP, sfinkterotomi, balon ile tarama ve plastik stent uygulamasý yöntemi hem oldukça etkin, hem de güvenilir bir seçenektir. Bu hasta grubunda ilk tercih edilecek tedavi yaklaþýmý olarak deðerlendirilmelidir.

Efficacy and safety of endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy and biliary stenting in post-operative bile leaks

BACKGROUND: We evaluated the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy, balloon biliary tract scanning, and plastic stenting in diagnosing and treating bile duct leakage after laparoscopic cholecystectomy and hydatid cyst surgery in this study.
METHODS: The study evaluated patients who underwent ERCP, sphincterotomy, and stenting for post-operative bile leakage. The patients were grouped under 4 groups (cystic duct stump, sac bed, hydatid cyst, and choledochal) according to the bile leakage de-tected in the ERCP procedure. The success of the procedure after the ERCP was evaluated by drain extraction time, whether early complications such as bleeding, pancreatitis, and perforation developed due to the ERCP procedure and the presence of obstructive pathology in ERCP.
RESULTS: Clinical improvement was observed in 65/73 (89%) patients who underwent successful ERCP procedures, and their drains could be removed. The mean drain removal time was 32.69±23.32 days. After laparoscopic cholecystectomy, bile leakage was most frequently from the cystic duct stump. There was no difference between the groups in procedural success rates. Drain removal time was shorter in the patient group with leakage from the cystic duct compared to the other three groups (P<0.05). After the ERCP procedure, 5/73 (6.9%) patients had minor ERCP complications, which improved with medical treatment. No major ERCP complication was observed. In addition, 25/73 patients (34.2%) had obstructive pathology such as biliary stone and hydatid membrane.
CONCLUSION: In patients with biliary leak due to laparoscopic cholecystectomy and hydatid cyst surgery, ERCP, sphincterotomy, balloon scanning, and plastic stenting are both highly effective and reliable options. They should be considered as the first-choice treat-ment approach in this patient group.