BENİGN BİLİER OBSTRÜKSİYONLARDA PERKÜTAN TEDAVİ GİRİŞİMLERİ (K.GÜREL, 2001)
Thesis Type: Expertise In Medicine
Institution Of The Thesis: Gazi University, Tıp Fakültesi, Dahili Tıp Bilimleri, Turkey
Approval Date: 2001
Thesis Language: Turkish
Student: KAMİL GÜREL
Supervisor: Erhan Turgut Ilgıt
Abstract:90 SUMMARY Purpose: Evaluation of efficiency in management of benign biliary strictures, mostly arising from iatrogenic/hepaticoenterostomy strictures and retained-recurrent bile duct stones, by interventional radiological techniques. Material and method: During the last six years, 29 lesions were detected in 26 patients who had benign biliary obstruction. Percutaneous interventional procedures (transhepatic: n=23; trans T- tube: n=3) were performed in all patients who had iatrogenic strictures (n=9), hepaticoenterostomy strictures (n=6) and choledocholithiasis (n=14)). The interventional procedures were balloon dilatation (n=13), metallic stent placement (n=2), balloon sphincteroplasty and stone repulsion (n=ll), stone repulsion after stricture dilatation (n=l) and guidance for failure of endoscopic sphincterotomy (n=2). Results: All benign biliary strictures were successfully treated by balloon dilatation and/or stent placement, except one stricture at one patient patient who had biliary obstruction at two levels as a complication of laparoscopic cholesystectomy. In two patients balloon dilatation was performed in more than one segment. In one of fourteen choledocholithiasis, repulsion of stone at the level of hepaticoenterostomy stricture, into the jejunum was achieved after ballooon dilatation. In two patients endoscopic sphincterotomy were guided by percutaneously inserted guide wire. In 10 patients stone repulsion into the duodenum was performed with vascular balloon catheter following balloon dilatation. In one patient repulsion of the stone into the duodenum was not succeeded because of the inefficient reduction of stone size (3cm). One patient had bilious pleural effusion because of transpleural catheter placement and sepsis occurred. No other major complications were observed. Conclusion: The treatment of benign bilary obstructions arising from iatrogenic/ hepaticoenterostomy strictures can be achieved by percutaneous interventional procedures but their long-term patency is not better than surgery. For this reason, this is recommended only for patients who are at high risk for surgery or who prefer nonsurgical treatment. Treatment of benign biliary obstruction with metallic endoprothesis is not favourable in long- term results and also can make the reconstructive surgery harder. We don't recommend using metallic stents for benign biliary obstruction. Repulsion of 0.5-3 cm big bile duct stones into duodenum after balloon sphincteroplasty, is less invasive and more physyological than stone removal by choledochotomy and endoscopic sphincterotomy. This method must be the preffered as the first step of treatment in selected patients of benign biliary obstruction.