Celal ÇERÇİ, Altuğ ŞENOL, M. Cem KOÇKAR, Muhammed AKÇAOĞLU, Nihat KAYMAKÇIOĞLI

Laparoskopik kolesistektomiye bağlı safra yolları yaralanmalarının endoskopik tedavisi

Laparoskopik kolesistektomi sonrası oluşan safra yolu yaralanmaları halen ciddi bir morbidite ve mortalite nedeni olarak görülmektedir. Laparoskopik kolesistektomi sonrası oluşan safra yolu yaralanmalarının sonuçlarını incelemek amacı ile 2005-2006 yılları arasında laparoskopik kolesistektomi sonrası safra yolu yaralanması şüphesiyle kliniğimize sevk edilen 9'u kadın, 5'i erkek olmak üzere toplam 14 hasta incelenmiştir. Hastaların tümüne endoskopik retrograd kolanjiopankreatografi (ERCP) yapılmıştır. Koledokta proksimalde tam obstrüksiyon, distalde kontrast madde kaçağı saptanan 4, ve sistik kanal güdüğünden kaçak tespit edilen 1 hastaya cerrahi tamir işlemi yapılmıştır. 9 hastanın ise ERCP ile tanıları konulduktan sonra, 3 hastaya sfinkterotomi ve stent, 3 hastaya sfinkterotomi ve nazobiliyer drenaj kateteri, 2 hastaya sadece stent yerleştirmek sureti ile ve bir hasta sadece sfinkterotomi uygulanarak tedavi edilmiştir. Toplam olarak safra yolu yaralanması bulunan 14 hastanın 9'u (%64) yalnızca ERCP ile tedavi edilirken, ERCP sonrası hiçbir hastada pankreatit dahil herhangi bir komplikasyon saptanmamıştır. Sonuç olarak laparoskopik kolesistektomi sonrası sık görülen safra yolları yaralanmalarının tanı ve tedavisinde ERCP emin ve etkili bir yöntem olup, cerrahi öncesi mutlaka düşünülmesi gereken bir yöntemdir.

Anahtar Kelimeler:

Kolesistektomi, laparoskopik, Kolanjiyopankreatografi, endoskopik retrograd, Yaralar ve yaralanmalar, Geriyedönük çalışma, Safra kanalları

Endoscopic treatment of bile duct injuries following laparoscopic cholecystectomy

Bile duct injury is still a common cause of morbidity and mortality following laparoscopic cholecystectomy. In a retrospective study, we analyzed 14 patients (9 female, 5 male) who referred to our hospital with iatrogenic bile duct injury due to primary laparoscopic cholecystectomy between 2005-2006. Endoscopic retrograde cholangiopancreatography (ERCP) was performed to all patients. Surgical procedures were performed to 4 patients with complete occlusion of common bile duct and biliary leakage and one patient with biliary leakage from the cystic duct. ERCP+sphincterotomy+stent to three patient, ERCP+sphincterotomy+nasobiliary stent to three patients, ERCP+stent to two patients and ERCP + sphincterotomy to one patient were performed endoscopically. Nine of 14 patients (64%), who had bile duct injury fallowing laparoscopic cholecystectomy, were treated endoscopically and no complication was occurred. ERCP is a safe and effective method in the treatment of bile duct injuries following laparoscopic cholecystectomy and must be performed to all patients even before surgery.

Keywords:

Cholecystectomy, Laparoscopic, Cholangiopancreatography, Endoscopic Retrograde, Wounds and Injuries, Retrospective Studies, Bile Ducts,

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