Bora BARUT, Fatih GÖNÜLTAŞ, Volkan İNCE, Hüseyin YÖNDER

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

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.

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

Background: The purpose of this study is to present our experience of diagnosis, clinical course, treatment and outcome in iatrogenic and traumatic bile duct injury. Methods:Sixteen patients, who were treated due to iatrogenic and traumatic bile duct injury between June 2009 and October 2014 at İnönü Universty, were analysed retrospectively. Result: Of the sixteen patients with bile duct injury, 4 (%25) were males and 12 (%75) were females. 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 emergency surgery due to trauma in our center. 14 (%87.5) patients were operated previously in other clinics 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) were treated with Roux-en-Y hepaticojejunostomy.The average length of stay of patients in the hospital 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 cause severe morbidity and mortality. Laparoscopic cholecystectomy is still the most common cause of bile duct injury.Regardless of their causes, bile duct injurys are serious conditions that require experienced treatment in terms of management. The time between onset of bile duct injury and surgical procedure is insignificant and treatment may give successful results in centers with experienced surgeons in hepatobiliary surgery.

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Flum DR, Cheadle A, Prela C, Dellinger EP, Chan L. Bile duct injury during cholecystectomy and survival in medicare beneficiaries. JAMA 2003;290:2168-73.
Machado NO. Biliary complications postlaparoscopic cholecystectomy: mechanism, preventivemeasures, and approach tomanagement: a review. Diagn Ther Endosc 2011;2011:967017.
Giger U, Ouaissi M, Schmitz SFH, Krahenbühl S, Krahenbühl L. Bile duct injury and use of cholangiography during laparoscopic cholecystectomy, Br J Surg 2011;98(3):391-6.
Sawaya DE Jr, Johnson LW, Sittig K, Mc Donald JC, Zibari GB. Iatrogenic and noniatrogenic extrahepatic biliary tract injuries: a multi-institutional review. Am Surg 2001;67:473-7.
Holte K, Bardram L, Wettergren A, Rasmussen A. Reconstruction of major bile duct injuries after laparoscopic cholecystectomy. Dan Med Bull 2010;57(2):A4135
Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995;180(1):101-25.
Savader SJ, Lillemoe KD, Prescott CA, Winick AB, Venbrux AC, Lund GB at all. Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg 1997;225(3):268-73.
Strasberg MS, Soper N. Benign Biliary Strictures. In: Cameron JL ed. Current Surgical Therapy. 8 th edition. Philadelphia: Elseiver-Mosby, 2004. p. 410-5.
Fletcher DR, Hobbs MS, Tan P, Valinsky LJ, Hockey RL, Pikora TJ et al. Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population based study. Ann Surg 1999; 229(4):449-57.
Jablonska B, Lampe P. Latrogenic bile duct injuries: etiology, diagnosis and management. World J Gastroenterol 2009;15(33):4097-104.
Feliciano DV. Biliary injuries as a result of blunt and penetrating trauma. Surg Clin North Am 1994;74:897-907.
Schmidt SC, Settmacher U, Langrehr JM, Neuhaus P. Management and outcome of patients with combined bile duct and hepatic arterial injuries after laparoscopic cholecystectomy. Surgery 2004;135(6):613-8.
Bektas H, Schrem H, Winny M, Klempnauer J. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg 2007;94(9):1119-27.
Jablonska B. Hepatectomy for bile duct injuries: when is it necessary? World J Gastroenterol 2013;19(38):6348-52.
Jablonska B, Lampe P, Olakowski M, Gorka Z, Lekstan A, Gruszka T. Hepaticojejunostomy vs. end-to-end biliary reconstructions in the treatment of iatrogenic bile duct injuries. J Gastrointest Surg 2009;13(6):1084-93.
Terblanche J, Worthley C, Krige J. High or low hepaticojejunostomy for bile duct strictures? Surgery 1990;108(5):828-34.
Rossi RL, Tsao JI. Biliary reconstruction. Surg Clin North Am 1994;74(4):825-41.
Nielsen ML, Jensen SL, Malmstrom J, Nielsen OV. Gastrin and gastric acid secretion in hepaticojejunostomy Roux-en- Y. Surg Gynecol Obstet 1980;150(1):61-4.
Imamura M, Takahashi M, Sasaki I, Yamauchi H, Sato T. Effects of the pathway of bile flow on the digestion of FAT and the release of gastrointestinal hormones. Am J Gastroenterol 1988;83(4):386-92.
Ramesh H, Prakash K, Kuruvılla K, Philip M, Jacob G, Venuqopal B et al. Biliary access loops for intrahepatic stones: results of jejunoduedonal anostomosıs. ANZ J Surg 2003;73(5):306-12
Schmidt SC, Langrehr JM, Hintze RE, Neuhaus P. Long-term results and risk factors influencing outcome of major bile duct injuries following cholecystectomy. Br J Surg 2005;92(1):76-82.
Mercado MA, Chan C, Salgado-Nesme N, Lopez-Rosales F. Intrahepatic repair of bile duct injuries. A comparative study. J Gastrointest Surg 2008;12(2):364-8.