Comparison of endoscopic therapeutic modalities for postoperative biliary fistula of liver hydatid cyst: A retrospective multicentric study
Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, cilt.20, sa.4, ss.223-227, 2010 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 20 Sayı: 4
- Basım Tarihi: 2010
- Doi Numarası: 10.1097/sle.0b013e3181e12ee6
- Dergi Adı: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Sayfa Sayıları: ss.223-227
- Anahtar Kelimeler: biliary fistula, hydatid disease, ERCP, biliary stent
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Hydatid disease most commonly affects the liver, and rupture into the bile ducts is a frequent complication occurring in 5% to 25% of patients. Biliary endoscopic procedures have become the treatment of choice for the management of biliary fistulae. Objective parameters for the endoscopic management of biliary fistulas are still necessary. Methods: In this multicentric retrospective study, a total of 109 patients who underwent surgery for a hydatid cyst localized to the liver and presented with persistent drainage of bile from a lodge drain after surgical intervention were included in this study. All patients were treated by an endoscopic retrograde cholangiopancreatography. Patients were divided into 3 groups according to the therapeutic endoscopic procedure: group 1 (n: 70) included patients who underwent only endoscopic sphincterotomy; group 2 (n: 22) included patients who had a 10F biliary stent inserted; and group 3 (n: 17) included patients who had a 7F biliary stent inserted. Recorded data were reviewed and the groups were compared. Results: The mean daily fistula output was 247mL (range: 100 to 600mL) in group 1, 534mL (range: 200 to 1000mL) in group 2, and 372mL (range: 120 to 780mL) in group 3, respectively. There were significant differences between the sphincterotomy group and the stenting groups (P<0.001). The closure time of the external biliary fistula was 23.7 days (range: 6 to 60d) in group 1, 12.6 days (range: 7 to 23d) in group 2, and 20 days (range: 6 to 33d) in group 3, respectively. When compared with the sphincterotomy group, the fistula closure time was shorter in group 2 than in group 1 (P<0.001). There were no differences in this respect between the groups 1 and 3 (P=0.214). Group 2 also had a shorter fistula closure time than group 3 (P<0.001). There was no mortality in any of the study groups. Mild bleeding was observed in 3 cases in group 1 and in 1 in group 3. CONCULUSIONS: Endoscopic retrograde cholangiopancreatography and related therapeutic procedures are safe and valuable in the postoperative management of external biliary fistulae in the hepatic hydatid disease. In high-output fistulae (>300mL/d), indicating a major cystobiliary communication, stent placement may be preferred. The diameter of the stent should preferably be 10F. This 10F stent is superior to other endoscopic approaches in the treatment of biliary fistulas. Copyright © 2010 by Lippincott Williams & Wilkins.