An algorithm for the treatment of the biliary complications of hepatic hydatid disease

POLAT, K. Yalçın; ÖREN, Durkaya; ATAMANALP, S. Selçuk; BAŞOĞLU, Mahmut; AYDINLI, Bülent; ÖZTÜRK, Gürkan; KISAOĞLU, Abdullah; YILDIRGAN, M. İlhan

An algorithm for the treatment of the biliary complications of hepatic hydatid disease

Gürkan ÖZTÜRK, (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

M. İlhan YILDIRGAN, (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

S. Selçuk ATAMANALP, (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

Mahmut BAŞOĞLU, (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

Bülent AYDINLI, (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

K. Yalçın POLAT, (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

Durkaya ÖREN, (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

Abdullah KISAOĞLU (Atatürk Üniversitesi, Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, Erzurum, Türkiye)

Turkish Journal of Medical Sciences

1 0

Yıl: 2009 Cilt: 39 Sayı: 5 Sayfa Aralığı: 671 - 685 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

An algorithm for the treatment of the biliary complications of hepatic hydatid disease

Öz:

Amaç: Karaciğer hidatik hastalığının (KHH) tedavisi artık standardize edilmiştir. KHH’nın safra yolunda oluşturduğu komplikasyonlar hem tedaviyi hem de hastalığın seyrini komplike hale getirmektedir. KHH’nın biliyer komplikasyonları ve tedavisi hakkında çok sayıda çalışmalar yapılmıştır. Biz bu çalışmada KHH’nın biliyer komplikasyonlarının tedavisi üzerine kendi deneyimlerimize dayalı bir algoritma öne sürdük.Yöntem ve gereçler: Ocak 2000 ile Aralık 2006 tarihleri arasında Atatürk Üniversitesi Tıp Fakültesi Genel Cerrahi AD, Endoskopi Ünitesinde 148 hastaya komplike KHH için endoskopik retrograd kolanjio- pankreatografi (ERKP) yapıldı. Hastaların yaşları, cinsiyetleri, ERKP ve endoskopik sfinkterotomi (ES) endikasyonları, laboratuar verileri, ameliyat bulguları, ameliyat sonrası komplikasyonlar ve başka girişimler (cerrahi veya perkütan) kaydedildi.Bulgular: Yirmi altı hasta daha önceden KHH için ameliyat olmamıştı. Bunları 23’üne ameliyattan önce 3’üne ise hem ameliyattan önce hem de ameliyattan sonra ERKP yapıldı. Geri kalan 122 hasta ise KHH nedeniyle ameliyat edilmiş hastalardı ve bunlara ameliyattan sonraki dönemde ERKP yapıldı.Ameliyat öncesi dönemde ERKP endikasyonları kolanjit ve kisto-biliyer iştirake ait, karaciğer fonksiyon testlerinde (bilirubin, ALT, AST, GGT, ALP) anormallikler, biliyer kolik ve tıkanma sarılığı gibi klinik bulguların varlığıydı. Bu grupta 2 hastada ERCP/ES başarılı olmadı ve bu hastalar acil şartlarda ameliyat edildi ve başka 3 hastada ameliyattan sonra safra fistülü gelişti.Ameliyat sonrası dönemde ERKP için endikasyonlar KHH’nın cerrahi tedavisinden sonra persistan safra fistülü, ameliyat sonrası bilirubin yükselmesi ve kolanjit ve kist boşluğunda ameliyat sonrasında biloma oluşmasıydı. Kolanjitli tüm hastalarda ERKP ve ES sonrası semptomlar geriledi, bilomalı bir hasta ve persistan safra fistülü olan 5 hasta ameliyat edildi.Sonuç: Biz KHH’nın biliyer komplikasyonlarının tedavisinde ERKP ve ES’nin çok etkili olduğu sonucuna vardık. İlk girişime cevap vermeyen hastalarda ERKP tekrar edilmelidir.

Anahtar Kelime: Komplikasyonlar Safra yolu Kolanjiyopankreatografi, endoskopik retrograd Ekinokokkoz Algoritma

Konular: Cerrahi

Karaciğer hidatik hastalığının biliyer komplikasyonlarının tedavisi için bir algoritma

Öz:

Abstract: Aim: The treatment of hepatic hydatid disease (HHD) is currently standardized. Biliary complications of HHD complicate both the treatment and course of the disease. Several investigations have been performed on the biliary complications of HHD and their treatment. We propose an algorithm for the treatment of the biliary complications of HHD based on our experience. Materials and methods: We investigated 148 patients that underwent endoscopic retrograde cholangiopancreatography (ERCP) due to complicated HHD between January 2000 and December 2006 at the endoscopy unit of the Department of Surgery of Atatürk University Medical School. Age, sex, indications for ERCP and endoscopic sphincterotomy (ES), ERCP findings, laboratory data, operative findings, postoperative complications, and additional interventions (surgical or percutaneous) were noted. Results: Twenty-six patients had not previously undergone surgery for HHD. While 23 of these patients underwent ERCP preoperatively, 3 underwent ERCP during both the pre- and postoperative periods. The remaining 122 patients underwent surgery for HHD and ERCP during the postoperative period. Indications for preoperative ERCP were cholangitis and various clinical signs of cysto-biliary communication (CBC), such as abnormal liver function test results (bilirubin, ALT, AST, GGT, and ALP), biliary colic, and obstructive jaundice. In this group of patients ERCP/ES was not successful in 2 patients that underwent surgery due to emergent circumstances, and another 3 patients developed postoperative biliary fistulae. Indications for postoperative ERCP were persistent bile leakage after surgical treatment for HHD, postoperative hyperbilirubinemia and cholangitis, and postoperative biloma formation in the cystic cavity. All patients with cholangitis experienced relief of symptoms after ERCP and ES, 1 patient with biloma formation and 5 patients with persistent biliary fistulae were operated on. Conclusion: ERCP and ES are highly effective in the treatment of the biliary complications of HHD. Repeat ERCP should be performed in patients that do not respond to the first intervention.

Anahtar Kelime: Algorithms Complications Biliary Tract Cholangiopancreatography, Endoscopic Retrograde Echinococcosis

Konular: Cerrahi

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. WHO Informal Working Group on Echinococcosis. Guidelines for treatment of cystic and alveolar echinococcosis in humans. Bull WHO 1996; 74: 231-242.
2. Ozaslan E, Bayraktar Y. Endoscopic therapy in the management of hepatobiliary hydatid disease. J Clin Gastroenterol 2002; 35: 160-174.
3. Kayaalp C, Bzeizi K, Demirbag AE, Akoglu M. Biliary complications ater hydatid liver surgery: incidence and risk factors. J Gastrointest Surg. 2002; 6: 706-12.
4. Becker K, Frieling T, Saleh A, Häussinger D. Resolution of hydatid liver cyst by spontaneous rupture into the biliary tract. J Hepatol. 1997; 26: 1408-12.
5. Galati G, Sterpetti AV, Caputo M, Adduci M, Lucandri G, Brozzetti S et al. Endoscopic retrograde cholangiography for intrabiliary rupture of hydatid cyst. Am J Surg 2006; 191: 206-210.
6. Cottone M, Amuso M, Cotton PB. Endoscopic retrograde cholangiography in hepatic hydatid disease. Br J Surg 1978; 65: 107-8.
7. Balik AA, Başoğlu M, Celebi F, Oren D, Polat KY, Atamanalp SS, et al. Surgical treatment of hydatid disease of the liver: review of 304 cases. Arch Surg. 1999; 134: 166-9.
8. Lygidakis NJ. Diagnosis and treatment of intrabiliary rupture of hydatid cyst of the liver. Arch Surg 1983; 118: 1186-9.
9. Alper A, Ariogul O, Emre A, Uras A, Okten A. Choledochoduodenostomy for intrabiliary rupture of hydatid cysts of liver. Br J Surg. 1987; 74: 243-5.
10. Akkiz H, Akinoglu A, Çolakoglu S, Demiryurek H, Yagmur O. Endoscopic management of biliary hydatid disease. Can J Surg 1996; 39: 287-92.
11. Yildirgan MI, Başoğlu M, Atamanalp SS, Aydinli B, Balik AA, Celebi F et al. Intrabiliary rupture in liver hydatid cysts: results of 20 years' experience. Acta Chir Belg. 2003; 103: 621-5.
12. Langer JC, Rose DB, Keystone JS, Taylor BR, Langer B. Diagnosis and management of hydatid disease of the liver. A 15-year North American experience. Ann Surg. 1984; 199: 412-7.
13. Kayaalp C, Bostanci B, Yol S, Akoglu M. Distribution of hydatid cysts into the liver with reference to cystobiliary communications and cavity-related complications. Am J Surg. 2003; 185: 175-9.
14. Akinoglu A, Bilgin I, Erkoçak EU. Surgical management of hydatid disease of the liver. Can J Surg 1985; 28: 171-4.
15. Bedirli A, Sakrak O, Sozuer EM, Kerek M, Ince O. Surgical management of spontaneous intrabiliary rupture of hydatid liver cysts. Surg Today. 2002; 32: 594-7.
16. Demircan O, Baymus M, Seydaoglu G, Akinoglu A, Sakman G. Occult cystobiliary communication presenting as postoperative biliary leakage ater hydatid liver surgery: are there signiicant preoperative clinical predictors? Can J Surg. 2006; 49: 177-84.
17. Ponchon T, Bory R, Chavaillon A. Endoscopic retrograde cholangiography and sphincterotomy for complicated hepatic hydatid cyst. Endoscopy 1987; 19: 174-7.
18. Magistrelli P, Masetti R, Coppola R, Costamagna G, Durastante V, Nuzzo G et al. Value of ERCP in the diagnosis and management of pre- and postoperative biliary complications in hydatid disease of the liver. Gastrointest Radiol. 1989; 14: 315-20.
19. Rabenstein T, Schneider HT, Hahn EG, Ell C. 25 years of endoscopic sphincterotomy in Erlangen: assessment of the experience in 3498 patients. Endoscopy 1998; 30: 194-201.
20. Shemesh E, Friedman E. Radiologic and endoscopic appearance of intrabiliary rupture of hydatid liver disease. Digestion 1987; 36: 96-100
21. Spiliadis C, Georgopoulos S, Dailianas A, Konstantinidis A, Rimikis M, Skandalis N. he use of ERCP in the study of patients with hepatic Echinococcus before and ater surgical intervention. Gastrointest Endosc 1996; 43: 575-9.
22. Al-Karawi MA, Yasawy MI, El Shiekh Mohamed AR. Endoscopic management of biliary hydatid disease: report on six cases. Endoscopy 1991; 23: 278-81.
23. Shemesh E, Klein E, Abramowich D, Pines A. Common bile duct obstruction caused by hydatid daughter cysts-- management by endoscopic retrograde sphincterotomy. Am J Gastroenterol. 1986; 81: 280-2.
24. Van Steenbergen W, Fevery J, Broeckaert L. Hepatic echinococcosis ruptured into the biliary tract: clinical, radiologic and therapeutic features during ive episodes of spontaneous biliary rupture in three patients with hepatic hydatidosis. J Hepatol 1987; 4: 133-9.
25. Del Olmo L, Merono E, Moreira VF, García T, García-Plaza A. Successful treatment of postoperative external biliary istulas by endoscopic sphincterotomy. Gastrointest Endosc 1988; 34: 307- 9.
26. Akoglu M, Hilmioglu F, Balay AR, Sahin B, Davidson BR. Endoscopic sphincterotomy in hepatic hydatid disease open to the biliary tree. Br J Surg. 1990; 77: 1073. 27. Bilsel Y, Bulut T, Yamaner S, Buyukuncu Y, Bugra D, Akyuz A et al. ERCP in the diagnosis and management of complications ater surgery for hepatic echinococcosis. Gastrointest Endosc 2003; 57: 210-213 28. Sanchez del Rio AL, Alguacil LV, De Dios Vega JF, Fugarolas GM. Efectiveness of endoscopic sphincterotomy in complicated hepatic hydatid disease. Gastrointest Endosc 1998; 48: 593-597.
29. Dumas R, Le Gall P, Hastier P, Buckley MJ, Conio M, Delmont JP. he role of endoscopic retrograde cholangiopancreatography in the management of hepatic hydatid disease. Endoscopy 1999; 31: 242-7.
30. Aretxabala X, Perez OL. he use of endoprostheses in biliary istula of hydatid cyst. Gastrointest Endosc 1999; 49: 797-9.
31. Sáez-Royuela F, Yuguero L, López-Morante A, Pérez-Alvarez JC, Martín-Lorente JL, Ojeda C. Acute pancreatitis caused by hydatid membranes in the biliary tract: treatment with endoscopic sphincterotomy. Gastrointest Endosc 1999; 49: 793-6.
32. Hilmioglu F, Karincaoglu M, Yilmaz S, Yildirim B, Kirimlioglu V, Aladag M et al. Complete treatment of ruptured hepatic cyst into biliary tree by ERCP. Dig Dis Sci 2001; 46: 463-7.
33. Cicek B, Parlak E, Disibeyaz S, Oguz D, Cengiz C, Sahin B. Endoscopic therapy of hepatic hydatid cyst disease in preoperative and postoperative settings. Dig Dis Sci 2007; 52: 931-5.
34. Al Karawi MA, Mohamed AR, Yasawy I, Haleem A. Non-surgical endoscopic trans-papillary treatment of ruptured Echinococcus liver cyst obstructing the biliary tree. Endoscopy 1987; 19:81-3.
35. Agarwal S, Sikora SS, Kumar A, Saxena R, Kapoor VK. Bile leaks following surgery for hepatic hydatid disease. Indian J Gastroenterol 2005; 24: 55-8.
36. Lee DW, Chan AC, Lam YH, Ng EK, Lau JY, Law BK et al. Biliary decompression by nasobiliary catheter or biliary stent in acute suppurative cholangitis: a prospective randomized trial. Gastrointest Endosc 2002; 56: 361-5.
37. Christoforidis E, Vasiliadis K, Goulimaris I, Tsalis K, Kanellos I, Papachilea T et al. D. A single center experience in minimally invasive treatment of postcholecystectomy bile leak, complicated with biloma formation. J Surg Res 2007; 141: 171-5.
38. Akcakaya A, Sahin M, Karakelleoglu A, Okan I. Endoscopic stenting for selected cases of biliary istula ater hepatic hydatid surgery. Surg Endosc 2006; 20: 1415-8.
39. Atli M, Kama NA, Yuksek YN, Doganay M, Gozalan U, Kologlu M, Daglar G. Intrabiliary rupture of a hepatic hydatid cyst: Associated clinical factors and proper management. Arch Surg 2001; 136: 1249-55.
40. Vagianos C, Androulakis JA. Capsectomy and drainage in hepatic hydatidosis. Dig Surg 1997; 14: 241-4.
41. Binmoeller KF, Katon RM, Shneidman R. Endoscopic management of postoperative biliary leaks: review of 77 cases and report of two cases with biloma formation. Am J Gastroenterol 1991; 86: 227-31.
42. Rösch W, Koch H, Demling L. Manometric studies during ERCP and endoscopic papillotomy. Endoscopy 1976; 8: 30-3.
43. Sharma BC, Agarwal N, Garg S, Kumar R, Sarin SK. Endoscopic management of liver abscesses and cysts that communicate with intrahepatic bile ducts. Endoscopy 2006; 38: 249-53.
44. Giouleme O, Nikolaidis N, Zezos P, Budas K, Kastinelos P, Vasiliadis T et al. Treatment of complications of hepatic hydatid disease by ERCP. Gastrointest Endosc 2001; 54: 508- 510.
45. Moreno Gonzalez E, Rico Selas P, Martinez B, Garcia I, Palma Carazo F, Hidalgo Pascual M. Results of surgical treatment of hepatic hydatidosis: current therapeutic modiications. World J Surg 1991; 15: 254-263.
46. Saioleas M, Misiakos E, Manti C, Katsikas D, Skalkeas G. Diagnostic evaluation and surgical management of hydatid disease of the liver. Word J Surg 1994; 18: 859-865.
47. Saritas U, Parlak E, Akoglu M, Sahin B. Efectiveness of endoscopic treatment modalities in complicated hepatic hydatid disease ater surgical intervention. Endoscopy 2001; 33: 858-63.
48. Dolay K, Akçakaya A, Soybir G, Cabioğlu N, Müslümanoğlu M, Iğci A et al. Endoscopic sphincterotomy in the management of postoperative biliary istula A complication of hepatic hydatid disease. Surg Endosc 2002; 16: 985-8.
49. Tekant Y, Bilge O, Acarli K, Alper A, Emre A, Arioğul O. Endoscopic sphincterotomy in the treatment of postoperative biliary istulas of hepatic hydatid disease. Surg Endosc 1996; 10: 909-11.
50. Goldin E, Katz E, Wengrower D, Kluger Y, Haskel L, Shiloni E, et al. Treatment of istulas of the biliary tract by endoscopic insertion of endoprostheses. Surg Gynecol Obstet 1990; 170: 418-423.
51. Marks JM, Ponsky JL, Shillingstad RB, Singh J. Biliary stenting is more efective than sphincterotomy in the resolution of biliary leaks. Surg Endosc 1998; 12: 327-30.
52. Vignote ML, Mino G, de la Mata M, de Dios JF, Gomez F. Endoscopic sphincterotomy in hepatic hydatid disease open to the biliary tree. Br J Surg 1990; 77: 30-31.

APA	ÖZTÜRK G, YILDIRGAN M, ATAMANALP S, BAŞOĞLU M, AYDINLI B, POLAT K, ÖREN D, KISAOĞLU A (2009). An algorithm for the treatment of the biliary complications of hepatic hydatid disease. , 671 - 685.
Chicago	ÖZTÜRK Gürkan,YILDIRGAN M. İlhan,ATAMANALP S. Selçuk,BAŞOĞLU Mahmut,AYDINLI Bülent,POLAT K. Yalçın,ÖREN Durkaya,KISAOĞLU Abdullah An algorithm for the treatment of the biliary complications of hepatic hydatid disease. (2009): 671 - 685.
MLA	ÖZTÜRK Gürkan,YILDIRGAN M. İlhan,ATAMANALP S. Selçuk,BAŞOĞLU Mahmut,AYDINLI Bülent,POLAT K. Yalçın,ÖREN Durkaya,KISAOĞLU Abdullah An algorithm for the treatment of the biliary complications of hepatic hydatid disease. , 2009, ss.671 - 685.
AMA	ÖZTÜRK G,YILDIRGAN M,ATAMANALP S,BAŞOĞLU M,AYDINLI B,POLAT K,ÖREN D,KISAOĞLU A An algorithm for the treatment of the biliary complications of hepatic hydatid disease. . 2009; 671 - 685.
Vancouver	ÖZTÜRK G,YILDIRGAN M,ATAMANALP S,BAŞOĞLU M,AYDINLI B,POLAT K,ÖREN D,KISAOĞLU A An algorithm for the treatment of the biliary complications of hepatic hydatid disease. . 2009; 671 - 685.
IEEE	ÖZTÜRK G,YILDIRGAN M,ATAMANALP S,BAŞOĞLU M,AYDINLI B,POLAT K,ÖREN D,KISAOĞLU A "An algorithm for the treatment of the biliary complications of hepatic hydatid disease." , ss.671 - 685, 2009.
ISNAD	ÖZTÜRK, Gürkan vd. "An algorithm for the treatment of the biliary complications of hepatic hydatid disease". (2009), 671-685.

APA	ÖZTÜRK G, YILDIRGAN M, ATAMANALP S, BAŞOĞLU M, AYDINLI B, POLAT K, ÖREN D, KISAOĞLU A (2009). An algorithm for the treatment of the biliary complications of hepatic hydatid disease. Turkish Journal of Medical Sciences, 39(5), 671 - 685.
Chicago	ÖZTÜRK Gürkan,YILDIRGAN M. İlhan,ATAMANALP S. Selçuk,BAŞOĞLU Mahmut,AYDINLI Bülent,POLAT K. Yalçın,ÖREN Durkaya,KISAOĞLU Abdullah An algorithm for the treatment of the biliary complications of hepatic hydatid disease. Turkish Journal of Medical Sciences 39, no.5 (2009): 671 - 685.
MLA	ÖZTÜRK Gürkan,YILDIRGAN M. İlhan,ATAMANALP S. Selçuk,BAŞOĞLU Mahmut,AYDINLI Bülent,POLAT K. Yalçın,ÖREN Durkaya,KISAOĞLU Abdullah An algorithm for the treatment of the biliary complications of hepatic hydatid disease. Turkish Journal of Medical Sciences, vol.39, no.5, 2009, ss.671 - 685.
AMA	ÖZTÜRK G,YILDIRGAN M,ATAMANALP S,BAŞOĞLU M,AYDINLI B,POLAT K,ÖREN D,KISAOĞLU A An algorithm for the treatment of the biliary complications of hepatic hydatid disease. Turkish Journal of Medical Sciences. 2009; 39(5): 671 - 685.
Vancouver	ÖZTÜRK G,YILDIRGAN M,ATAMANALP S,BAŞOĞLU M,AYDINLI B,POLAT K,ÖREN D,KISAOĞLU A An algorithm for the treatment of the biliary complications of hepatic hydatid disease. Turkish Journal of Medical Sciences. 2009; 39(5): 671 - 685.
IEEE	ÖZTÜRK G,YILDIRGAN M,ATAMANALP S,BAŞOĞLU M,AYDINLI B,POLAT K,ÖREN D,KISAOĞLU A "An algorithm for the treatment of the biliary complications of hepatic hydatid disease." Turkish Journal of Medical Sciences, 39, ss.671 - 685, 2009.
ISNAD	ÖZTÜRK, Gürkan vd. "An algorithm for the treatment of the biliary complications of hepatic hydatid disease". Turkish Journal of Medical Sciences 39/5 (2009), 671-685.