Somatostatin Infusions Reduce Post-Operative Bile Leak after Hepatopancreatobiliary Surgery: An Observational Preliminary Study
Pitiakoudis Michael *
2nd Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Zezos Petros
Gastrointestinal Endoscopy Unit, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Kouklakis Georgios
Gastrointestinal Endoscopy Unit, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Fotakis Stelios
2nd Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Romanidis Konstantinos
2nd Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Nagorni Eleni-Aikaterini
2nd Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Tsalikidis Christos
2nd Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Botaitis Sotirios
2nd Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
Iatrou Christos
Department of Anesthesiology, Democritus University of Thrace, Greece.
Simopoulos Constantinos
2nd Department of Surgery, Democritus University of Thrace, University General Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece.
*Author to whom correspondence should be addressed.
Abstract
Background: Bile leak is a complication of hepatopancreatobiliary surgery and results from injury to the bile ducts. Treatment usually consists of percutaneous drainage combined with the placement of a biliary stent or a nasobiliary draining tube in the biliary tree via endoscopic retrograde cholangiopancreatography. Animal experiments and studies in humans have shown that somatostatin reduces bile secretion.
Objective: To evaluate the efficacy of somatostatin as a conservative monotherapy for the successful management of mild to moderate post-operative bile leak.
Place and Duration of Study: 2nd Department of at the University General Hospital of Alexandroupolis, during the period of 2010 and 2012.
Patients and Methods: Fifteen patients (11male/4 female) with a mean age of 70.1±4.2 years who developed uncomplicated post-operative bile leak with a daily output ranging from 100ml to 800ml were included in the study. Eleven patients were operated for benign diseases of the liver and biliary tract, while the rest 4 patients for pancreatic or biliary tract malignancies. Somatostatin was administered intravenously to all patients in continuous infusions of 3000μg/12hours until complete recession of bile leak along with total parenteral nutrition.
Results: Somatostatin treatment was successful in 14 patients (93.3%), with success being defined as the complete cessation of bile leak. Overall, mean duration of bile leak was 13.8±3.9 days. No major adverse reactions or complications were observed and no patients died.
Conclusions: Somatostatin appears to be effective in the treatment of post-operative bile leak. The efficacy of somatostatin is observed both in patients with benign or malignant disease.
Keywords: Somatostatin, postoperative, bile leak, hepatopancreatobiliary surgery