Nurettin TUNC, Mustafa GİRGİN, Ibrahim Halil BAHCECİOGLU, Mehmet YALNİZ

Efficacy and safety of nasobiliary drain in patients with postoperative biliary leakage

The aim of the present study is to examine the efficacy of nasobiliary drainage with endoscopic retrograde cholangiopancreaticography on the necessity of a subsequent surgery or endoscopic or radiological intervention for patients with biliary leakage. 37 cases of bile leakage were followed. The location of the biliary leakage with endoscopic retrograde cholangiopancreaticography, the presence of post-endoscopic retrograde cholangiopancreaticography complications and whether a second surgery was performed were retrospectively reviewed. The study sample included 37 patients, namely 22 women and 15 men. The average age of the patients was 45.6 years. The biliary leakage identified among the patients (26/37) by way of the endoscopic retrograde cholangiopancreaticography procedure was located in their intrahepatic biliary tract in 27.0%, their gallbladder cavity in 37.8%, and the hilar region in 5.4%, and was unspecified suspected leakage in 29.7%. 24 (64.8%) of the cases had undergone cholecystectomy and 10 (27.0%) hydatid cyst surgery, while one of case lobectomy + cholecystectomy and 2 of sharp-object injuries. Their average duration of hospitalisation was 17.7 days. The cases that had undergone surgery for hydatid cysts exhibited an average duration of hospitalisation of 24.6 days. Nasobiliary drainage had secured medical treatment without the need for a surgical intervention in 91.9% of the cases. Experienced medical centres should primarily prefer the effective and reliable procedure of endoscopic retrograde cholangiopancreaticography and the administration of nasobiliary drain as highly successful method for the non-surgical treatment of postoperative biliary leakage.

PDF

___

Connor S and Garden OJ. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg 2006; 93:158-68.

Hogan AM, Hoti E, Winter DC, at al. Quality of life after iatrogenic bile duct injury: a case control study. Annals of Surgery 2009;249:292–5

Gennaro N, Felice G, Ivo G, et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian National Survey on 56 591 cholecystectomies. Arch Surg 2005;140:986-92.

Larson GM, Vitale GC, Casey J, et al. Multipractice analysis of laparoscopic cholecystectomy in 1983 patients. Am J Surg 1992;163:221-6.

Barkun AN, Rezieg M, Mehta SN, et al. Postcholecystectomy biliary leaks in the laparoscopic era: risk factors, presentation, and management. McGill Gallstone Treatment Group. Gastrointest Endosc 1997;45:277-82.

Sadamori H, Yagi T, Matsuda H, et al. Intractable bile leakage after hepatectomy for hepatocellular carcinoma in 359 recent cases. Dig Surg 2012;29:149-56.

Vecchio R, MacFadyen BV, Latteri S. Laparoscopic cholecystectomy: an analysis on 114,005 cases of United States series. Int Surg Jul 1998;83:215-9.

Kapoor V, Baron RL and Peterson MS. Bile Leaks After Surgery. AJR Am J Roentgenol 2004;182:451-8.

Pachter HL, Hofstetter SR. The current status of nonoperative management of adult blunt hepatic injuries. Am J Surg 1995;169:442-54.

10. Carrillo EH, Spain DA, Wohltmann CD, et al. Interventional techniques are useful adjuncts in nonoperative management of hepatic injuries. J Trauma 1999;46:619-22.

11. Capussotti L, Ferrero A, Viganò L, et al. Bile leakage and liver resection: where is the risk? Arch Surg 2006;141:690-4.

12. Dasgupta TK, Sharma V. Intrahepatic bilomas--a possible complication of cholecystectomy? Br J Clin Pract 1992;46:272-3.

13. Adler DG, Papachristou GI, Taylor LJ. et al. Clinical outcomes in patients with bile leaks treated via ERCP with regard to the timing of ERCP: a large multicenter study. Gastrointest Endosc 2017;85:766-72.

14. Pinkas H, Brady PG. Biliary leaks after laparoscopic cholecystectomy: time to stent or time to drain. Hepatobiliary Pancreat Dis Int 2008;7:628-32.

15. McLindon JP, England RE, Martin DF. Causes, clinical features and nonoperative management of bile leaks. Eur Radiol 1998;8:1602-7.

16. Chen XP, Peng SY, Peng CH. et al. A ten year study on non-surgical treatment of postoperative bile leakage. World J Gastroenterol 2002;8:937-42.

17. Kaffes AJ, Hourigan L, De Luca N, et al. Impact of endoscopic intervention in 100 patients with suspected postcholecystectomy bile leak. Gastrointest Endosc. 2005;61:269-75.

18. Tewani SK, Turner BG, Chuttani R, et al. Location of bile leak predicts the success of ERCP performed for postoperative bile leaks. Gastrointest Endosc. 2013;77:601-8.

19. Schlumpf R, Klotz HP, Wehrli H, et al. A nation’s experience in laparoscopic cholecistectomy. Prospective multicentricanalyssis of 3722 cases. Surgical Endosc 1994;8:35-41.

20. Collet D, Edye M, Perrisat J. Conversion and complications of laparoscopic cholecystectomy. Results of a survey conducted French Society of endoscopic surgery and interventional radiology. Surg Endosc 1993;7:334-8.

21. Cuschieri A, Dubois F, Mouiel J, et al. The European experience with laparoscopic cholecystectomy. Am J Surg 1991;161:385-7.

22. Mergener K, Strobel JC, Suhocki P, at al. The role of ERCP in diagnosis and management of accessory bile duct leaks after cholecystectomy. Gastrointest Endosc 1999;50:527–31.

23. Ryan ME, Geehen JE, Lehman GA, et al. Endoscopic intervention for biliary leaks after laparoscopic cholecystectomy: a multicentre review. Gastrointest Endosc 1998;47:261–6.

24. Ramesh H. Post cholecystectomy bile leaks and their management. Gastrointest Endosc 1998;47:564–5.

25. Tsolakis AV, James PD, Kaplan GG, et al. A clinical prediction rule to determine the need for repeat ERCP after endoscopic treatment of postsurgical bile leaks. Gastrointest endosc 2017;85:1047-56.

26. Agarwal S, Sikora SS, Kumar A, et al. Bile leaks following surgery for hepatic hydatid disease. Indian J Gastroenterol 2005;24:55-8.

27. De Backer A, Fierens H, De Schepper A, et al. VaneerdewegW. Diagnosis and nonsurgical management of bile leak complicated by biloma after blunt liver injury: report of two cases. Eur Radiol 1998;8:1619-22.