Fatih Gönültaş, Volkan İnce, Hüseyin Yönder, Bora Barut

İyatrojenik ve Travmatik Safra Yolu Yaralanmalarındaki Klinik Deneyimlerimiz: Bir Retrospektif Analiz

Amaç: Bu çalışmanın amacı; iyatrojenik ve travmatik safra yolu yaralanmalarının tanı, klinik seyir, tedavi ve sonuçlarına ilişkin deneyimlerimizi sunmaktır. Gereç-Yöntem: Haziran 2009- Ekim 2014 tarihleri arasında İnönü Üniversitesi Genel Cerrahi Kliniği’nde iyatrojenik veya travmatik, safra yolu yaralanması nedeniyle tedavi edilen 16 hasta retrospektif olarak incelendi. Bulgular: Safra yolu yaralanması olan 16 hastanın 4 (%25)’ü erkek, 12 (%75)’si kadın idi. Safra yolu yaralanmalarının 3 (%18.75)’ü travmaya, 13 (%81.25)’ü laparaskopik kolesistektomi ameliyatına bağlı olarak meydana gelmişti. 2 (%12.5) hasta travma nedeniyle tarafımızdan acil ameliyata alınmıştı. 14 (%87.5) hasta ise başka merkezlerde daha önce ameliyat edilip, komplikasyon gelişmesi üzerine kliniğimize sevk edilmişti. Safra yolu yaralanmalarının tedavisinde 1 (%6.25) hastaya uç uca anastomoz, 15 (%93.75) hastaya Roux-n Y hepatikojejunostomi yapıldı. Hastalara ait hastanede kalış süresi ortalama : 18.9 gün ve ortalama takip süresi: 25.6 ay idi. Sonuç: Safra yolu yaralanmaları iyatrojenik veya travmatik nedenlerle meydana gelebilir ve ciddi mortalite ve morbiditeye neden olabilir. Laparaskopik kolesistektomi ameliyatları halen safra yolu yaralanmalarının en sık sebebidir. Safra yolu yaralanmaları; nedeni ne olursa olsun, tedavi yönetimi açısından ciddi deneyim gerektiren bir durumdur. Safra yolu yaralanmasının oluş zamanı ile biliyer rekonstrüksiyonun yapılma zamanı arasındaki süreden bağımsız olarak, hepatobiliyer cerrahi konusunda tecrübeli klinikler tarafından yapılan biliyer rekonstrüksiyon işlemi ile başarılı sonuçlar alınabilir

Our Clinical Experience in Iatrogenic and Traumatic Bile Duct Injury: A Retrospective Analysis

Background: The purpose of this study is to present our experience of diagnosis, clinicalcourse, treatment and outcome in iatrogenic and traumatic bile duct injury.Methods: Sixteen patients, who were treated due to iatrogenic and traumatic bile ductinjury between June 2009 and October 2014 at İnönü Universty, were analysedretrospectively.Result: Of the sixteen patients with bile duct injury, 4 (%25) were males and 12 (%75) werefemales. 3 (%18.75) of the bile duct injuries occured due to trauma and 13(%81.25)occurred due to laparoscopic cholecystectomy. 2 (%12.5) patients were taken to emergencysurgery due to trauma in our center. 14 (%87.5) patients were operated previously in otherclinics and referred to our center due to complications. In the treatment of bile duct injury,1 (%6.25) patient underwent duct to duct anastomosis while the others 15 (%93.75) weretreated with Roux-en-Y hepaticojejunostomy. The average length of stay of patients in thehospital was18.9 days, and the average follow-up time was 25.6 months.Conclusion: Bile duct injury may occur with iatrogenic or traumatic causes and can causesevere morbidity and mortality. Laparoscopic cholecystectomy is still the most commoncause of bile duct injury.Regardless of their causes, bile duct injurys are serious conditionsthat require experienced treatment in terms of management. The time between onset ofbile duct injury and surgical procedure is insignificant and treatment may give successfulresults in centers with experienced surgeons in hepatobiliary surgery.

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