Introduction: Reconstruction of the biliary tract is a necessary surgery in many diseases such as surgical palliation in malignant biliary obstructions, or repair after bile duct injury due to iatrogenic causes and for other miscellaneous diseases because a series of concomitant complications is associated with biliary loss, including the formation of intra-abdominal abscesses that can frequently determine mortality In the present study the prognostic factors of biliary loss were studied, with particular attention to the impact of surgical bypass. Materials and Methods: The study included n 41 all patients observed since January 2003 and December 2013 at the polyclinic AOU University of Catania DPt general surgery and specialist II of which 12 males and 29 females average age 62.5 years (35-90). affected by perforaton of the duodenum or lesions of the biliary tract of the middle and proximal choledochus. Signs and symptoms included abdominal pain, dyspnoea, tachycardia, fever (O39.5 C),. the presence of bile was demonstrated radiologically in the pelvic excavation for more than 24 hours after endoscopic treatment. And the perioperative predictive factors were then analyzed by comparing the two groups of patients with and without biliary surgical bypass to determine which variables were significant for the success of the surgical treatment Results: In the first group of patients with duodenal micro perforation and biliary leak that occurred after they had undergone an endoscopic sphincterotomy. The analysis of the results showed how conservative therapy with the application of the PTDA procedure with the application of abdominal drainages and the derivation of the bile duct, with the closure with the application of endoclip on the duodenal perforation, associated with the intake of antibiotics and the maintenance of positioned trans-cutaneous discharges, with fasting and NPT that allowed to resolve the bile losses after a mean hospital stay of 60 days In patients with a wider duodenal perforation, with concurrent lesion of the middle and terminal choledochus, and with a loss biliary that after 24 hours was significant so as to form a bile collection and intra-abdominal abscesses it was preferred to implement an interventional surgical management. In performing a laparotomy in these patients, bile collection drainage was performed with abdominal lavage until the abdominal cavity was cleared of all debris. To all this was associated the jejunal loop repair and the execution of a biliodigestive derivation. Discussion: The present study showed that a clinically relevant biliary leak after hepaticodigunostomy, and biliary drainage with PTDA occurred after the anastomosis was performed on the segmental ducts that are independent predictors. Early PTDA is a safe and adequate treatment strategy, in patients who had biliary losses within 24 hours e. the rate of relaparotomy has decreased significantly. Confirming as for other authors that the proximal bile duct resections had the highest incidence of leakage. The rate of loss after a bileodigestive bypass procedure for palliation or obstructive jaundice treatment was low, (2%) The surgical palliative of the bile digestive bypass remains an adequate procedure in an unresectable disease Conclusions: The procedures of bile digestive bypass in association with PTDA remain in unresectable neoplasms of the biliary tract a main and safe indication, integrating and ensuring the possibility of carrying out complementary therapies.

MANAGEMENT OF THE BILE DUCT AFTER IATROGENIC INIURY

Buffone, Antonino
Membro del Collaboration Group
;
Graziano, Antonino;Graziano, Giorgio Maria.
2019

Abstract

Introduction: Reconstruction of the biliary tract is a necessary surgery in many diseases such as surgical palliation in malignant biliary obstructions, or repair after bile duct injury due to iatrogenic causes and for other miscellaneous diseases because a series of concomitant complications is associated with biliary loss, including the formation of intra-abdominal abscesses that can frequently determine mortality In the present study the prognostic factors of biliary loss were studied, with particular attention to the impact of surgical bypass. Materials and Methods: The study included n 41 all patients observed since January 2003 and December 2013 at the polyclinic AOU University of Catania DPt general surgery and specialist II of which 12 males and 29 females average age 62.5 years (35-90). affected by perforaton of the duodenum or lesions of the biliary tract of the middle and proximal choledochus. Signs and symptoms included abdominal pain, dyspnoea, tachycardia, fever (O39.5 C),. the presence of bile was demonstrated radiologically in the pelvic excavation for more than 24 hours after endoscopic treatment. And the perioperative predictive factors were then analyzed by comparing the two groups of patients with and without biliary surgical bypass to determine which variables were significant for the success of the surgical treatment Results: In the first group of patients with duodenal micro perforation and biliary leak that occurred after they had undergone an endoscopic sphincterotomy. The analysis of the results showed how conservative therapy with the application of the PTDA procedure with the application of abdominal drainages and the derivation of the bile duct, with the closure with the application of endoclip on the duodenal perforation, associated with the intake of antibiotics and the maintenance of positioned trans-cutaneous discharges, with fasting and NPT that allowed to resolve the bile losses after a mean hospital stay of 60 days In patients with a wider duodenal perforation, with concurrent lesion of the middle and terminal choledochus, and with a loss biliary that after 24 hours was significant so as to form a bile collection and intra-abdominal abscesses it was preferred to implement an interventional surgical management. In performing a laparotomy in these patients, bile collection drainage was performed with abdominal lavage until the abdominal cavity was cleared of all debris. To all this was associated the jejunal loop repair and the execution of a biliodigestive derivation. Discussion: The present study showed that a clinically relevant biliary leak after hepaticodigunostomy, and biliary drainage with PTDA occurred after the anastomosis was performed on the segmental ducts that are independent predictors. Early PTDA is a safe and adequate treatment strategy, in patients who had biliary losses within 24 hours e. the rate of relaparotomy has decreased significantly. Confirming as for other authors that the proximal bile duct resections had the highest incidence of leakage. The rate of loss after a bileodigestive bypass procedure for palliation or obstructive jaundice treatment was low, (2%) The surgical palliative of the bile digestive bypass remains an adequate procedure in an unresectable disease Conclusions: The procedures of bile digestive bypass in association with PTDA remain in unresectable neoplasms of the biliary tract a main and safe indication, integrating and ensuring the possibility of carrying out complementary therapies.
biliary derivation drainage
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/370881
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