Restrospective Analysis of the Patients with Choledochoduodenostomy in Benign and Malignant Distal Choledochal Stenosis
Abstract
Objective: The aim of this study was to
determine the suitability of the choledochoduodenostomy for treatment of benign
and malignant distal common bile duct stenosis and also, to investigate the
relationship between preoperative biochemical data and the causes of
obstructive jaundice.
Material
and Method: Patients with the diagnosis of
choledocholithiasis or pancreatic carcinoma who underwent
choledochoduodenostomy between 2014-2018 years were included in the study.
Patients were divided into two groups according to their preoperative diagnosis:
patients diagnosed with choledocholithiasis (KDL group n=29) and patients
diagnosed with pancreatic carcinoma (PCA group; n=5). Demographic
characteristics and laboratory data of the patients were compared.
Results: No
statistically significant difference was found between the groups in terms of
age, gender, length of hospital stay, operation and mortality rates
(p>0.05). Anastomotic leakage was not observed in both groups. Preoperative
measured ALT, GGT, total bilirubin and direct bilirubin levels of patients in
the pancreatic carcinoma group were higher than the patients in the KDL group
(p<0.05).
Conclusion: This
study suggests that preoperative ALP, GGT, total bilirubin and direct bilirubin
levels can be used as an adjunctive biomedical marker for prediction of
pancreatic cancer in patients for whom choledochoduodenostomy is planned for
obstructive jaundice. Despite the disadvantages, choledochoduodenostomy should
be a preferable method in the treatment of distal choledochal obstruction when
endoscopic methods are inadequate.
References
- 1. Okamoto H, Miura K, Itakura J, Fujii H. Current assessment of choledochoduodenostomy: 130 consecutive series. Ann R Coll Surg Engl. 2017; 99(7):545-9.
- 2. Luu C, Lee B, Stabile BE. Choledochoduodenostomy as the biliary enteric bypass of choice for benign and malignant distal common bile duct strictures. Am Surg. 2013;79(10):1054-57.
- 3. Cotton PB, Geenen JE, Sherman S, Cunningham JT, Howell DA, Carr-Locke DL et al. Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts. Ann Surgery. 1998;227(2):201-4.
- 4. Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN et al. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointestinal Endoscopy. 1996; 44(6):643-9.
- 5. Sahiner IT, Kendirci M. Retrospective clinical study of the effects of T-tube placement for bile duct stricture. Med Sci Monit. 2017;23:4328-33.
- 6. Kneuertz PJ, Cunningham SC, Cameron JL, Torrez S, Tapazoglou N, Herman JM et al. Palliative surgical management of patients with unresectable pancreatic adenocarcinoma: trends and lessons learned from a large, single institution experience. J Gastrointest Surg. 2011;15(11):1917-27.
- 7. Madden JL, Chun JY, Kandalaft S, Parekh M. Choledochoduodenostomy: an unjustly maligned surgical procedure? Am J Surg. 1970;119(1):45-54.
- 8. Panis Y, Fagniez PL, Brisset D, Lacaine F, Levard H, Hay JM. Long term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis. The French Association for Surgical Research. Surg Gynecol Obstet. 1993;177(1):33-7.
- 9. Mezhir JJ, Brennan MF, Baser RE, D’Angelica MI, Fong Y, DeMatteo RP et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13(12):2163-9.
- 10. Di Fronzo LA, Egrari S, O'connell TX. Choledochoduodenostomy for palliation in unresectable pancreatic cancer. Arch Surg. 1998;133(8):820-5.
- 11. Escudero-Fabre A, Escallon Jr A, Sack J, Halpern NB, Aldrete JS. Choledochoduodenostomy. Analysis of 71 cases followed for 5 to 15 years. Ann Surg. 1991;213(6):635-42.
- 12. Parrilla P, Ramirez P, Bueno FS, Perez J, Candel M, Muelas M et al. Long term results of choledochoduodenostomy in the treatment of choledocholithiasis: Assessment of 225 cases. Br J Surg. 1991;78(4):470-2.
BENİGN VE MALİGN DİSTAL KOLEDOK DARLIKLARINDA KOLEDOKODUODENOSTOMİ YAPILAN HASTALARIN RETROSPEKTİF ANALİZİ
Abstract
Amaç: Bu çalışmanın amacı koledokoduodenostomi
girişiminin benign ve malign distal koledok darlıklarında kullanım için
uygunluğunu belirlemek ve aynı zamanda preoperatif biyokimya verileri ile
tıkanma sarılığı sebepleri arasındaki ilişkiyi karşılaştırmaktır.
Gereç ve Yöntem: Koledokolitiyazis veya pankreas
karsinomu tanısı bulunan ve 2014-2018 yılları arasında koledokoduodenostomi
yapılan hastalar çalışmaya dahil edildi. Hastalar, preoperatif tanılarına göre
koledokolitiyazis tanısı konulan hastalar (KDL grubu n=29), pankreas karsinomu
tanısı konulan hastalar (PCA grubu; n=5) olmak üzere iki gruba ayrıldı.
Hastaların demografik özellikleri ve laboratuvar verileri karşılaştırıldı.
Bulgular: Yaş, cinsiyet, hastanede yatış
süresi, operasyona alınma şekli ve ölüm oranları bakımından iki hasta grubu
arasında fark saptanmadı (p>0.05). Her iki grupta da anastomoz kaçağı
görülmedi. Pankreas karsinomu grubundaki hastaların preoperatif ölçülen ALT,
GGT, total bilirubin ve direkt bilirubin düzeyleri, KDL grubundaki hastalardan
daha yüksek bulundu (p <0.05)
Sonuç: Bu çalışma verileri tıkanma sarılığı
sebebi ile koledokoduodenostomi planlanan hastalarda preoperatif ALP, GGT,
total bilirubin ve direkt bilirubin seviyelerinin, altta yatan sebebi pankreas
kanseri açısından öngörmede yardımcı bir biyomedikal marker olarak
kullanılabilme olasılığını akla getirmektedir. Koledokoduodenostomi,
dezavantajlarına rağmen, distal koledok tıkanıklığının tedavisinde endoskopik
yöntemlerin yetersiz kaldığı durumlarda tercih edilebilir bir yöntemdir.
References
- 1. Okamoto H, Miura K, Itakura J, Fujii H. Current assessment of choledochoduodenostomy: 130 consecutive series. Ann R Coll Surg Engl. 2017; 99(7):545-9.
- 2. Luu C, Lee B, Stabile BE. Choledochoduodenostomy as the biliary enteric bypass of choice for benign and malignant distal common bile duct strictures. Am Surg. 2013;79(10):1054-57.
- 3. Cotton PB, Geenen JE, Sherman S, Cunningham JT, Howell DA, Carr-Locke DL et al. Endoscopic sphincterotomy for stones by experts is safe, even in younger patients with normal ducts. Ann Surgery. 1998;227(2):201-4.
- 4. Bergman JJ, van der Mey S, Rauws EA, Tijssen JG, Gouma DJ, Tytgat GN et al. Long-term follow-up after endoscopic sphincterotomy for bile duct stones in patients younger than 60 years of age. Gastrointestinal Endoscopy. 1996; 44(6):643-9.
- 5. Sahiner IT, Kendirci M. Retrospective clinical study of the effects of T-tube placement for bile duct stricture. Med Sci Monit. 2017;23:4328-33.
- 6. Kneuertz PJ, Cunningham SC, Cameron JL, Torrez S, Tapazoglou N, Herman JM et al. Palliative surgical management of patients with unresectable pancreatic adenocarcinoma: trends and lessons learned from a large, single institution experience. J Gastrointest Surg. 2011;15(11):1917-27.
- 7. Madden JL, Chun JY, Kandalaft S, Parekh M. Choledochoduodenostomy: an unjustly maligned surgical procedure? Am J Surg. 1970;119(1):45-54.
- 8. Panis Y, Fagniez PL, Brisset D, Lacaine F, Levard H, Hay JM. Long term results of choledochoduodenostomy versus choledochojejunostomy for choledocholithiasis. The French Association for Surgical Research. Surg Gynecol Obstet. 1993;177(1):33-7.
- 9. Mezhir JJ, Brennan MF, Baser RE, D’Angelica MI, Fong Y, DeMatteo RP et al. A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: routine drainage is not justified. J Gastrointest Surg. 2009;13(12):2163-9.
- 10. Di Fronzo LA, Egrari S, O'connell TX. Choledochoduodenostomy for palliation in unresectable pancreatic cancer. Arch Surg. 1998;133(8):820-5.
- 11. Escudero-Fabre A, Escallon Jr A, Sack J, Halpern NB, Aldrete JS. Choledochoduodenostomy. Analysis of 71 cases followed for 5 to 15 years. Ann Surg. 1991;213(6):635-42.
- 12. Parrilla P, Ramirez P, Bueno FS, Perez J, Candel M, Muelas M et al. Long term results of choledochoduodenostomy in the treatment of choledocholithiasis: Assessment of 225 cases. Br J Surg. 1991;78(4):470-2.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | December 30, 2018 |
| Submission Date | November 1, 2018 |
| Published in Issue | Year 2018 Volume: 20 Issue: 3 |
Cite
Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.