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•Medical management of external biliary fistula following surgical treatment of hydatid cyst of the liver. Comparative study

Aqeel Raheem Al-Barqawi --- Adel Shaker Al- Tamimi

Karbala Journal of Medicine مجلة كربلاء الطبية
ISSN: 19905483 Year: 2011 Volume: 4 no 2 Issue: 10 Pages: 1067-1072
Publisher: Kerbala University جامعة كربلاء

Abstract

background: External biliary fistula is a common complication following more conservative hydatid liver surgery .A high output biliary fistula (drainage of more than 300ml of bile /day), might be associated with increasing morbidity. In the absence of distal biliary obstruction, the time required for fistula closure would be dependent upon many factors, among which the Oddi sphincter pressure is the most important. Lowering sphincter pressure has been tried by many methods including endoscopic and pharmacological methods depending on documented manometric studies.Objectives: To evaluate the effectiveness of combined oral administration of Nifidipin, Isosorbid dinitrate and hyocin butyl bromide in reducing the time required for closure of biliary fistula following hydatid liver surgery.Patients and methods: Fifty patient with high output biliary fistula (drainage of bile of more than 300ml/day) who underwent surgery for hydatid cyst of the liver in Al – Diwaniya and Baghdad teaching hospitals, 30 patients were subjected to a trial of combined oral administration of Oddi sphincter relaxant drugs, to evaluate the efficacy of this approach, they were compared with 20 patients in whom placebo was administered with no other intervention adopted.Results: The majority of patients ( 93.33%), the fistula output converted to a low one within 5 days following the initiation of sphincter relaxants therapy, as compared to only 10% of patients in the placebo group with obvious statistical difference . 73.3% of patients in the study group exhibit complete cessation of bile drainage within 2-10 days as compared to 60% in the placebo group in whom complete cessation occur within 20-40 days the difference was statistically significant. 90.3% of patients in the study group were discharged within 7 days a period which significantly shorter as compared to 90% of patients in the placebo group whose discharged within 2-3 weeks in an average.Conclusion: The administration of Oddi sphincter relaxant drugs may hasten the fistula closure with less morbidity and shorter hospital stay therefore it is a beneficial , safe and cost effective method in the management of external biliary fistula following hydatid liver surgery