The Role of Hepatobiliary Scintigraphy as the Initial Investigative Modality for Significant Bile Leak following Laparoscopic Cholecystectomy.

IF 1.8 3区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Digestive Surgery Pub Date : 2023-01-01 Epub Date: 2023-09-25 DOI:10.1159/000533794
Amitai Bickel, Ron Lagrissi, Jacqueline Jerushalmi, Wisam Sbeit, Michael Weiss, Moshe Shiller, Samer Ganam, Eli Kakiashvili
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引用次数: 0

Abstract

Introduction: Currently, the rate of bile duct injury and leak following laparoscopic cholecystectomy (LC) is still higher than for open surgery. Diverse investigative algorithms were suggested for bile leak, shifting from hepatobiliary scintigraphy (HBS) toward invasive and more sophisticated means. We aimed to analyze the use of biliary scan as the initial modality to investigate significant bile leak in the drain following LC, attempting to avoid potential unnecessary invasive means when the scan demonstrate fair passage of nuclear substance to the intestine, without leak.

Methods: We have conducted a prospective non-randomized study, mandating hepatobiliary scintigraphy first, for asymptomatic patients harboring drain in the gallbladder fossa, leaking more than 50 mL/day following LC. Analysis was done based on medical data from the surgical, gastroenterology, and the nuclear medicine departments.

Results: Among 3,124 patients undergoing LC, significant bile leak in the drain was seen in 67 subjects, of whom we started with HBS in 50 patients, presenting our study group. In 27 of whom, biliary scan was the only investigative modality, showing fair passage of the nuclear isotope to the duodenum and absence of leak in the majority. The leak stopped spontaneously within a mean of 3.6 days, and convalescence as well as outpatient clinic follow-up was uneventful. In 23 patients, biliary scan that was interpreted as abnormal was followed by endoscopic retrograde cholangio-pancreatography (ERCP). However, ERCP did not demonstrate any bile leak in 13 subjects. In 17 patients, ERCP was used initially, without biliary scan, suggesting the possibility of avoiding invasive modalities in 7 patients.

Conclusions: Based on a negative predictive value of 91%, we suggest that in cases of asymptomatic significant bile leak through a drain following LC, a normal HBS as the initial modality can safely decrease the rate of using invasive modalities.

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肝胆闪烁扫描作为腹腔镜胆囊切除术后显著胆汁渗漏的初步研究手段的作用。
引言:目前,腹腔镜胆囊切除术后胆管损伤和渗漏的发生率仍然高于开放手术。胆汁渗漏的研究算法多种多样,从肝胆闪烁扫描(HBS)转向侵入性和更复杂的方法。我们的目的是分析使用胆道扫描作为研究LC后引流管中显著胆汁泄漏的初始模式,试图避免在扫描显示核物质公平通过肠道而没有泄漏时潜在的不必要的侵入性手段。方法:我们进行了一项前瞻性非随机研究,要求首先对胆囊窝有引流管、LC后渗漏超过50mL/天的无症状患者进行肝胆闪烁扫描。根据外科、胃肠科和核医学部门的医学数据进行分析。结果:在3124名接受LC的患者中,67名受试者的引流管中出现了严重的胆汁泄漏,其中50名患者开始接受HBS治疗,这是我们的研究组。在其中27例患者中,胆道扫描是唯一的研究方式,显示核同位素可以顺利进入十二指肠,大多数患者没有渗漏。泄漏在平均3.6天内自动停止,恢复期和门诊随访都很顺利。在23例患者中,胆道扫描被解释为异常,随后进行内镜逆行胰胆管造影(ERCP)。然而,在13名受试者中,ERCP未显示任何胆汁渗漏。在17名患者中,最初使用ERCP,没有进行胆道扫描,这表明7名患者有可能避免采用侵入性方法。结论:基于91%的阴性预测值,我们建议,在LC后无症状显著胆汁通过引流管泄漏的病例中,正常的HBS作为初始模式可以安全地降低使用侵入性模式的比率。
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来源期刊
Digestive Surgery
Digestive Surgery 医学-外科
CiteScore
4.90
自引率
3.70%
发文量
25
审稿时长
3 months
期刊介绍: ''Digestive Surgery'' presents a comprehensive overview in the field of gastrointestinal surgery. Interdisciplinary in scope, the journal keeps the specialist aware of advances in all fields that contribute to improvements in the diagnosis and treatment of gastrointestinal disease. Particular emphasis is given to articles that evaluate not only recent clinical developments, especially clinical trials and technical innovations such as new endoscopic and laparoscopic procedures, but also relevant translational research. Each contribution is carefully aligned with the need of the digestive surgeon. Thus, the journal is an important component of the continuing medical education of surgeons who want their practice to benefit from a familiarity with new knowledge in all its dimensions.
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