Retrospective Evaluation of Endoscopic Treatment Outcomes in Biliary Leak After Hepatobiliary Surgery: Single Center Experience

Introduction: Biliary leak, after the hepatobiliary tract injuries, is a serious complication and can lead to morbidity and prolonged hospitalization. Endoscopic management has proved to be an effective treatment for the biliary leak. However, the most appropriate endoscopic intervention is still controversial and the long-term follow-up data of patients are limited. The aim of this study is to identify the efficacy of endoscopic treatment methods, to determine the biliary drainage devices and their duration period and to investigate the outcome of treatment in patients with biliary leak after hepatobiliary surgery. Materials and Methods: The Endoscopic Retrograde Cholangiopancrea tography (ERCP) procedures were held in Gastroenterology Endoscopy Unit between January 2016 and January 2017 and retrospectively evaluated. Patients were compared with the demographic characteristics, endoscopic treatment method (only sphincterotomy, stent insertion only, sphincterotomy+ stent insertion), biliary stent implantations, how many times ERCP was done, the time of healing bile leak and ERCP related complication. Results: A total of 1037 consecutive patients who underwent ERCP were scanned retrospective. 22 patients with bile leak fulfilled the criteria of study. In 20 patients with bile leakage associated with cholecystectomy, the leak was closed at the 6th week after ERCP procedure + biliary stent. In one of every 2 patients who developed biliary leakage secondary to cyst hydatid operation, the leakage was still persisted 6 weeks later. Therefore, plastic stents were inserted into the biliary system of those patients with two ERCP procedures by the three month intervals and bile leakcontinued for 30 weeks. In the other patient, since the biliary leakage was still persisted in the 6th week, after to ERCP procedure, 3 more plastic stent insertions + ERCPs with 3 months intervals were done (42 weeks) and the leak was closed. Conclusion: Our study demonstrates the efficacy of endoscopic treatment in bile leak patients after hepatobiliary surgery.

Hepatobiliyer Cerrahi Sonrası Biliyer Kaçakta Endoskopik Tedavi Sonuçlarının Retrospektif Değerlendirilmesi: Tek Merkez Deneyimi

Amaç: Safra yolu yaralanmaları sonrası oluşan biliyer kaçak, hepatobiliyer cerrahinin ciddi bir komplikasyonu olup morbidite ve uzamış yatışayol açabilir. Endoskopik tedavi biliyer kaçak için etkili bir tedavi olduğu kanıtlanmıştır. Ancak en uygun endoskopik müdahale hala tartışmalıolup hastaların uzun süreli takibi ile ilgili veriler kısıtlıdır. Bu çalışmanın amacı, hepatobiliyer cerrahi sonrası oluşan postoperatif biliyer kaçaktaendoskopik tedavi yöntemlerini, kullanılan biliyer drenaj araçlarını ve sürelerini belirlemek ve tedavi sonuçlarını araştırmaktır.Gereç ve Yöntem: Ankara Eğitim ve Araştırma Hastanesi Gastroenteroloji Endoskopik Retrograd Kolanjiyo Pankreatografinin (ERKP) Ünitesinde,Ocak 2016 ile Ocak 2017 tarihleri arasında yapılan ERKP işlemleri geriye yönelik tarandı. Hastaların demografik verileri, endoskopik tedavi yöntemi(sadece sfinkterotomi, sadece stent takılması, sfinkterotomi+stent takılması gibi), biliyer stent implantasyonları, kaç kez ERKP yapıldığı, kaçağındüzelme süresi ve ERKP işlemi ile ilişkili komplikasyonlar kaydedildi.Bulgular: ERKP uygulanan toplam 1037 hasta retrospektif olarak tarandı. Çalışmanın kriterlerini karşılayan 22 safra kaçağı hastası saptandı.Kolesistektomi ile ilişkili safra kaçağı olan 20 hastada kaçağın ERCP prosedürü+biliyer stent sonrası 6. hafta kapandığı saptandı. Kist hidatikoperasyonuna sekonder safra kaçağı gelişen her 2 hastadan birinde, 6 hafta sonra hala kaçak devam etti. Bu nedenle, 3 ay aralar ile iki ERCPprosedürü ile hastalanın biliyer sistemine plastik stentler yerleştirildi ve safra sızıntısı 30 hafta devam etti. Diğer hastada biliyer kaçak ERKP işleminin6. haftasında devam etmesi üzerine ise 3 ay aralar ile 3 ERKP+ plastik stentleme sonrası (42. haftada) kapandığı saptandı.Sonuç: Çalışmamız hepatobiliyer cerrahi sonrası biliyer kaçak olan hastaların tedavisinde endoskopik tedavinin etkinliğini göstermektedir.

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