Akut biliyer pankreatit tanýsýnda, izleminde ve tedavisinde farklý yaklaþýmlar: Tutum anketi sonuçlarý

AMAÇ: Akut biliyer pankreatit, acil cerrahi hastalýklarda genel cerrahlar arasýnda en sýk karþýlaþýlan hastalýklardan biridir. Hekimden hekime deðiþen bu hastalarýn taný ve tedavi yönetimindeki farklýlýklar klinik uygulamada sýk görülür. Bu farklýlýklarý sunmayý ve sonuçlarý literatürdeki güncel kýlavuzlar ýþýðýnda tartýþmayý amaçladýk.
GEREÇ VE YÖNTEM: Akut biliyer pankreatit tanýsýnda, takibinde ve tedavisinde hekimlerin yaklaþýmlarýna iliþkin 21 soru hazýrlandý (Ek-A). Anketler, 20. Ulusal Cerrahi Kongresi’nde 94 genel cerrahi uzmanýyla yüz yüze görüþülerek dolduruldu.
BULGULAR: Anketi cevaplayan hekimlerin 38’i (%40) eðitim ve araþtýrma hastanesinde, 27’si (%29) devlet hastanesi’nde, 19’u (%20) üniversite hastanesinde ve 9’u özel saðlýk kuruluþunda çalýþmakta idi. Hekimlerin %85’i 10 yýllýk deneyime sahip genel cerrahi uzmanlarýydý. Cerrahlarýn %53’ü (50) her ay beþten az akut biliyer pankreatit vakasý gördüðünü ve %35’i (34) takip için günlük olarak amilaz deðeri istediklerini belirtti. Ultrasonografi ve bilgisayarlý tomografi en sýk kullanýlan görüntüleme yöntemleri idi ve yanýt verenlerin %15’i her hastaya manyetik rezonans kolanjiyopankreatografi yaptýðýný belirtti. Cerrahlarýn %45’i pankreatit tanýsý sýrasýnda antibiyotik baþladýðýný belirtti. Hafif-orta þiddette pankreatitli hastalarda erken dönemde kolesistektomi yapmayan cerrahlarýn oraný %60 idi. Erken dönemde ameliyatý tercih etmeme nedeni %40 ile en sýk ameliyat zorluðu ve ameliyatý erken dönemde desteklememe fikri idi.
TARTIÞMA: Tutum anketi sonuçlarýna göre akut biliyer pankreatit tanýsý, takibi ve tedavisinde genel cerrahi uzmanlarý arasýnda farklýlýklar bulunmaktadýr.

Different approaches in diagnosis, follow-up and treatment of acute biliary pancreatitis: Results of attitude survey

BACKGROUND: Acute biliary pancreatitis is one of the most frequently encountered diseases among general surgeons in emergency surgical diseases. Differences in diagnosis and treatment management of these patients, varying from physician to physician, are common in clinical practice. We aimed to present these differences and discuss the results in the light of current guidelines in the literature.
METHODS: In this study, 21 questions were prepared regarding the physicians’ approach in the diagnosis, follow-up and treatment of acute biliary pancreatitis (Appendix).The questionnaires were completed by face to face interviews with 94 general surgery specialists at the 20th National Surgery Congress.
RESULTS: In this study, 38 (40%) of the physicians who answered the questionnaire were working in the Training and Research Hospital, 27 (29%) in the State Hospital, 19 (20%) in the University Hospital and nine in private health care was working in the establishment. 85% of the physicians were general surgery specialists with 10 years of experience. 53% (50) of the surgeons reported that they had less than five cases of acute biliary pancreatitis each month, and 35% (34) stated that they wanted amylase value daily for follow-up. Ultrasonography and computed tomography were the most commonly used imaging modalities and 15% of the respondents indicated that each patient underwent magnetic resonance cholangiopancreatography. 45% of surgeons stated that antibiotics were started at the time of diagnosis of pancreatitis. The percentage of surgeons who did not undergo cholecystectomy early in patients with mild to moderate pancreatitis was 60%. The reason for not preferring surgery in the early period was the most frequent operation difficulty with 40% and not supporting the operation in the early period.
CONCLUSION: According to the attitude survey results, there are differences between general surgery specialists in the diagnosis, follow-up and treatment of acute biliary pancreatitis.