Non-surgical treatment of post-surgical bile duct injury: clinical implications and outcomes

Autor: Young Ook Eum, Joo Kyung Park, Yong Tae Kim, Jin-Hyeok Hwang, Jaeyoung Chun, Sang Hyub Lee, Ho-Seong Han, Yong Bum Yoon, Ji Kon Ryu, Chang Jin Yoon
Rok vydání: 2013
Předmět:
Adult
Male
Post surgical
medicine.medical_specialty
Catheters
Cholangiopancreatography
Magnetic Resonance
medicine.medical_treatment
Anastomotic Leak
Constriction
Pathologic
Percutaneous transhepatic cholangiography
digestive system
Hospitals
University
Tertiary Care Centers
Sphincterotomy
Endoscopic
Young Adult
Republic of Korea
medicine
Humans
Aged
Aged
80 and over
Cholangiopancreatography
Endoscopic Retrograde
Cholestasis
Evidence-Based Medicine
business.industry
Bile duct
Gastroenterology
Non surgical treatment
General Medicine
Equipment Design
Middle Aged
Dilatation
Surgery
Biliary Tract Surgical Procedures
medicine.anatomical_structure
Treatment Outcome
Endoscopic retrograde cholangiography
Drainage
Female
Stents
Percutaneous transhepatic biliary drainage
Bile Ducts
business
Tomography
X-Ray Computed
Zdroj: World journal of gastroenterology. 20(22)
ISSN: 2219-2840
Popis: To investigate the prognostic factors determining the success rate of non-surgical treatment in the management of post-operative bile duct injuries (BDIs).The study patients were enrolled from the pancreatobiliary units of a tertiary teaching hospital for the treatment of BDIs after hepatobiliary tract surgeries, excluding operations for liver transplantation and malignancies, from January 1999 to August 2010. A total of 5167 patients underwent operations, and 77 patients had BDIs following surgery. The primary end point was the treatment success rate according to different types of BDIs sustained using endoscopic or percutaneous hepatic approaches. The type of BDI was defined using one of the following diagnostic tools: endoscopic retrograde cholangiography, percutaneous transhepatic cholangiography, computed tomography scan, and magnetic resonance cholangiography. Patients with a final diagnosis of BDI underwent endoscopic and/or percutaneous interventions for the treatment of bile leak and/or stricture if clinically indicated. Patient consent was obtained, and study approval was granted by the Institutional Review Board in accordance with the legal regulations of the Human Clinical Research Center at the Seoul National University Hospital in Seoul, South Korea.A total of 77 patients were enrolled in the study. They were divided into three groups according to type of BDI. Among them, 55 patients (71%) underwent cholecystectomy. Thirty-six patients (47%) had bile leak only (type 1), 31 patients had biliary stricture only (type 2), and 10 patients had both bile leak and biliary stricture (type 3). Their initial treatment modalities were non-surgical. The success rate of non-surgical treatment in each group was as follows: BDI type 1: 94%; type 2: 71%; and type 3: 30%. Clinical parameters such as demographic factors, primary disease, operation method, type of operation, non-surgical treatment modalities, endoscopic procedure steps, type of BDI, time to diagnosis and treatment duration were evaluated to evaluate the prognostic factors affecting the success rate. The type of BDI was a statistically significant prognostic factor in determining the success rate of non-surgical treatment. In addition, a shorter time to diagnosis of BDI after the operation correlated significantly with higher success rates in the treatment of type 1 BDIs.Endoscopic or percutaneous hepatic approaches can be used as an initial treatment in type 1 and 2 BDIs. However, surgical intervention is a treatment of choice in type 3 BDI.
Databáze: OpenAIRE
Externí odkaz: