Kolesistektomi Sonrası Biliyer Kaçak Gelişen Hastalarda Biliyer Stent ve Nazobiliyer Drenin Karşılaştırılması

Year 2023, Volume: 7 Issue: 3, 95 - 103, 19.01.2024

Mehmet Raşit Ayte , İlhami Yüksel

https://doi.org/10.33716/bmedj.1403519

Abstract

Amaç: Kolesistektomi sonrası gelişen biliyer kaçak tedavisinde Endoskopik Retrograd Kolanjiyopankreatografi (ERCP) ile yerleştirilen biliyer stent veya nazobiliyer dren (NBD) tercih edilen prosedürlerdir. Çalışmamızda, biliyer kaçak tespit edilen hastalarda NBD veya biliyer stentin etkinliğini karşılaştırmayı amaçladık.
Materyal ve metod: Postkoleksistektomi safra kaçağı olan 37 hasta çalışmaya dahil edildi. 20 hastaya biliyer stent, 17 hastaya NBD uygulandı. Hastalar; ek işlem gereksinimi, ERCP komplikasyonları, hastanede yatış süresi, toplam takip süresi açısından karşılaştırıldı.
Bulgular: Biliyer stent uygulanan 20 hastanın 11’inde (%55) sistik güdükten, 5’inde (%25) Luschka’dan, 4’ünde(%20) lateral duvardan kaçak vardı. Hastanede yatış süresi 10.5±7 gün iken, toplam takip süreleri 89.9±42.8 gün di. NBD uygulanan 17 hastanın 10’unda (%58.8) sistik güdükten, 4’ünde (%23.5) lutckadan , 2’sinde(%11.7) lateral duvardan, 1’inde (%5.8) sağ segmental duktustan kaçak vardı. Hastanede yatış süresi 11.9±3 gün iken, total takip süreleri 31.5±11.7 gündü. Ayrıca kaçak lokalizasyonuna gore; 1. grupta (Strazberg tip A) hospitalizasyon süresi 9±2.25 gün, toplam takip siresi 54.04±6.72 iken, 2. grupta (Strazberg tip A dışı) hastanede yatış süresi 16.9±2.68 gün, toplam takip süreleri 84±40,15 gündü.
Sonuç: Biliyer stent uygulanan hastalarda, hastanede yatış süresinin daha kısa olduğu ve komplikasyonların daha az geliştiği, tesbit edildi. NBD'li hastalarda toplam takip süreleri daha kısaydı. Ayrıca çalışmamız uygulanacak modalitenin belirlenmesinde kaçak yerinin de göz önüne alınması gerektiğini düşündürmektedir

Keywords

biliyer kaçak, biliyer stent, kolesistektomi, nazobiliyer dren

Comparison of biliary stent and nasobiliary drain in patients with biliary leak after cholecystectomy

Abstract

Objective: Biliary stent or nasobiliary drain (NBD) placed by Endoscopic Retrograde Cholangiopancreatography (ERCP) are the preferred procedures in the treatment of biliary leak that develops after cholecystectomy. In our study, we aimed to compare the effectiveness of NBD or biliary stent in patients with biliary leakage.
Materials and method: 37 patients with postcholecystectomy bile leaks were included in the study. Biliary stent was applied to 20 patients and NBD was applied to 17 patients. Patients; They were compared in terms of need for additional procedures, ERCP complications, hospital stay, and total follow-up time.
Results: Of the 20 patients to whom biliary stent was applied, 11 (55%) had leakage from the cystic duct, 5 (25%) had leakage from the Luschka, and 4 (20%) had leakage from the lateral wall. While the hospitalization time was 10.5±7 days, the total follow-up time was 89.9±42.8 days. Of the 17 patients who underwent NBD, 10 (58.8%) were from the cystic duct, 4 (23.5%) were from the Luschka, 2 (11.7%) were from the lateral wall, and 1 (5.8%) was from the right segmental duct. The hospitalization period was 11.9±3 days and the total follow-up period was 31.5±11.7 days. Additionally, depending on the leak location; In the 1st group (Strasberg type A), the hospitalization time was 9±2.25 days and the total follow-up time was 54.04±6.72 days, while in the 2nd group (non-Strasberg type A), the hospitalization time was 16.9±2.68 days and the total follow-up time was 84±40.15 days.
Conclusion: It was observed that the hospital stay was shorter and complications were less common in patients who received biliary stents total follow-up times were shorter in patients with NBD. Additionally, our study shows that the location of the leak is also important when determining the procedure to be applied

Keywords

biliary leak, biliary stent, cholecystectomy, nasobilier drain

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