Dergiler / Turkish Journal of Surgery / 2018 / Cilt: 34 - Sayı: 1
Management of iatrogenic injuries due to endoscopic sphincterotomy: Surgical or conservative approaches
- Sayfa
- 24–27
- DOI
- —
Özet
Objective: The best therapeutic approach for endoscopic retrograde cholangiopancreatography-related perforationsremains controversial; while some authors suggest routine conservative management, others advocate mandatorysurgical exploration. We aimed to evaluate our clinical experience of perforations during endoscopic sphincterotomy.Material and Methods: A retrospective chart review from January 2010 to October 2015 identified 20 patientswith endoscopic retrograde cholangiopancreatography-related perforations. Data collection included demographics,time to diagnosis, type of perforation, treatment strategy, surgical procedure, complications, hospital stay, andoutcome. All patients were classified into two groups on the basis of radiological and operative findings.Results: Only five patients underwent surgical treatment, whereas 15 patients were managed conservatively. Themean time to diagnosis was 7.8 hrs (range: 1 to 36 hrs). In patients who underwent surgical treatment, the types ofperforations included type I and III in one patient each and type II in three patients. Surgical procedures includedlaparoscopic and open cholecystectomy with t-tube drainage in two patients each and primary repair of duodenalinjury with hepaticojejunostomy in one patient. Among conservatively managed patients, eight, four, and three hadtype II, type III, and type IV injuries, respectively. Of these 15 patients, 60% (n=9) underwent percutaneous procedures.The mean length of hospital stay was similar for conservatively and surgically treated patients (12 vs. 12.4days, respectively, p=0.790). One patient (5%) with type I injury died of multiorgan deficiency.Conclusion: With close close clinical follow-up, medical treatment can be beneficial for most patients, and surgicalprocedures should be reserved for patients with type I (definite) and type II/III injuries; in patients with these clinicalparameters, conservative management will likely be unsuccessful.