Download PDF
Viszeralchirurgie 2007; 42(3): 157-164
DOI: 10.1055/s-2007-960719
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Gallengangsprobleme in der Leberchirurgie und Lebertransplantation

Bile Duct Complications Associated with Liver Surgery and Liver TransplantationS.-C. Schmidt1 , P. Neuhaus1
  • 1Universitätsmedizin Berlin, Charité Campus Virchow Klinikum, Klinik für Allgemein-, Visceral- und Transplantationschirurgie, Berlin
Further Information

Publication History

Publication Date:
27 June 2007 (online)

    Permissions and Reprints

Zusammenfassung

Trotz Verbesserung der chirurgischen Technik und Fortschritten in der perioperativen intensivmedizinischen Betreuung der Patienten inklusive der immunsuppressiven Therapie sind Gallengangskomplikationen in der Leberchirurgie und Lebertransplantation ein schwerwiegendes klinisches Problem, das mit einer erheblichen Morbidität und auch Mortalität behaftet ist. Stehen in der Leberchirurgie die postoperativen Leckagen im Vordergrund, so sind die Hauptprobleme nach Lebertransplantation die Gallengangstenosen. Durch die Etablierung der verschiedenen Formen der Teillebertransplantation hat sich das Spektrum der biliären Komplikationen erweitert. Entscheidend für die Prognose ist die frühzeitige Diagnostik und Therapie der Gallengangskomplikationen. Voraussetzung für eine zum langfristigen Erfolg führende Therapie ist die interdisziplinäre Zusammenarbeit zwischen Chirurgen, Endoskopikern und Radiologen.

Abstract

Despite advanced surgical techniques and improved perioperative intensive medical care of the patients, including immunosuppressive therapy, bile duct complications remain a profound clinical problem in liver surgery and liver transplantation, associated to extensive morbidity and mortality. Although, postoperative leakages are significant in liver surgery, bile duct stenosis remains a major problem after liver transplantation. Due to the development of various different methods of segmental liver transplantation, the spectrum of biliary complications has been significantly enhanced. Crucial for the prognosis is the early diagnosis and therapy of bile duct complications, and a prerequisite for a long-term therapeutical success is the interdisciplinary collaboration between the surgeons, endoscopists and radiologists.

Schlüsselwörter

Gallengangskomplikationen - Lebertransplantation - Leberchirurgie

Key words

Bile duct complications - liver transplantation - hepatic surgery

Literatur

  • 1 Bismuth H, Chiche L, Castaing D. Surgical treatment of hepatocellular carcinomas in noncirrhotic liver: experience with 68 liver resections.  World J Surg. 1995;  19 35-41
    PubMedGoogle Scholar
  • 2 Doci R, Gennari L, Bignami P. et al . Morbidity and mortality after hepatic resection of metastases from colorectal cancer.  Br J Surg. 1995;  82 377-381
    PubMedGoogle Scholar
  • 3 Shimada M, Matsumata T, Akazawa K. et al . Estimation of risk of major complications after hepatic resection.  Am J Surg. 1994;  167 399-403
    CrossrefPubMedGoogle Scholar
  • 4 Imamura H, Seyama Y, Kokudo N. et al . One thousand fifty-six hepatectomies without mortality in 8 years.  Arch Surg. 2003;  138 1198-1206
    CrossrefPubMedGoogle Scholar
  • 5 Jarnagin W R, Gonen M, Fong Y. et al . Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade.  Ann Surg. 2002;  236 397-406
    CrossrefPubMedGoogle Scholar
  • 6 Lam C M, Lo C M, Liu C L, Fan S T. Biliary complications during liver resection.  World J Surg. 2001;  25 1273-1276
    CrossrefPubMedGoogle Scholar
  • 7 Sanchez-Urdazpal L, Gores G J, Ward E M. et al . Ischemic-type biliary complications after orthotopic liver transplantation.  Hepatology. 1992;  16 49-53
    CrossrefPubMedGoogle Scholar
  • 8 Neuhaus P, Blumhardt G, Bechstein W O, Steffen R, Platz K P, Keck H. Technique and results of biliary reconstruction using side-to-side choledochocholedochostomy in 300 orthotopic liver transplants.  Ann Surg. 1994;  219 426-434
    CrossrefPubMedGoogle Scholar
  • 9 Lo C M, Shaked A, Busuttil R W. Risk factors for liver transplantation across the ABO barrier.  Transplantation. 1994;  15 543-547
    PubMedGoogle Scholar
  • 10 Ascher H L. Liver transplantation - the first 25 years.  West J Med. 1988;  149 316-321
    PubMedGoogle Scholar
  • 11 Buckels J AC. Liver transplantation. In: Forsythe JLR (Hrsg.). Saunders, London 1997; 165
    Google Scholar
  • 12 Lerut J, Gordon R D, Iwatsuki S. et al . Biliary tract complications in human orthotopic liver transplantation.  Transplantation. 1987;  43 47-51
    PubMedGoogle Scholar
  • 13 Stratta R J, Wood R P, Langnas A N. et al . Diagnosis and treatment of biliary tract complications after orthotopic liver transplantation.  Surgery. 1989;  106 675-683
    Google Scholar
  • 14 Rolles K, Dawson K, Novell R, Hayter B, Davidson B, Burroughs A. Biliary anastomosis after liver transplantation does not benefit from T tube splintage.  Transplantation. 1994;  57 402-404
    PubMedGoogle Scholar
  • 15 Randall H B, Wachs M E, Somberg K A, Lake J R, Emond J C, Ascher N L, Roberts J P. The use of the T tube after orthotopic liver transplantation.  Transplantation. 1996;  61 258-261
    PubMedGoogle Scholar
  • 16 Scatton O, Meunier B, Cherqui D. et al . 21. Randomized trial of choledochocholedochostomy with or without a T tube in orthotopic liver transplantation.  Ann Surg. 2001;  233 432-437
    CrossrefPubMedGoogle Scholar
  • 17 Vougas V, Rela M, Gane E, Muiesan P, Melendez H V, Williams R, Heaton N D. A prospective randomised trial of bile duct reconstruction at liver transplantation: T tube or no T tube?.  Transpl Int. 1996;  9 392-395
    CrossrefPubMedGoogle Scholar
  • 18 Thethy S, Thomson B NJ, Pleass H. et al . Management of biliary tract complications after orthotopic livertransplantation.  Clin Transplant. 2004;  18 647-653
    CrossrefPubMedGoogle Scholar
  • 19 Koivusalo A, Isoniemi H, Salmela K, Edgren J, Numers H von, Hockerstedt K. Biliary complications in one hundred adult liver transplantations.  Scand J Gastroenterol. 1996;  31 506-511
    PubMedGoogle Scholar
  • 20 Colonna 2nd  J O, Shaked A, Gomes A S. et al . Biliary strictures complicating liver transplantation. Incidence, pathogenesis, management, and outcome.  Ann Surg. 1992;  216 344-350
    PubMedGoogle Scholar
  • 21 Soejima Y, Taketomi A, Yoshizumi T. et al . Biliary strictures in living donor liver transplantation: incidence, management, and technical evolution.  Liver Transpl. 2006;  12 979-986
    CrossrefPubMedGoogle Scholar
  • 22 Greif F, Bronsther O L, Van Thiel D H. et al . The incidence, timing and management of biliary tract complications after orthotopic liver transplantation.  Ann Surg. 1994;  219 40-45
    CrossrefPubMedGoogle Scholar
  • 23 Starzl T E, Putnam C W, Hansbrough J F, Porter K A, Reid H A. Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair.  Surgery. 1977;  81 212-221
    PubMedGoogle Scholar
  • 24 Calne R Y. A new technique for biliary drainage in orthotopic liver transplantation utilizing the gall bladder as a pedicle graft conduit between the donor and recipient common bile ducts.  Ann Surg. 1976;  184 605-609
    PubMedGoogle Scholar
  • 25 Anselmi M, Sherlock D, Buist L. et al . Gallbladder conduit vs end-to-end anastomosis of the common bile duct in orthotopic liver transplantation.  Transplant Proc. 1990;  22 2295-2296
    PubMedGoogle Scholar
  • 26 Tung B Y, Kimmey M B. Biliary complications of orthotopic liver transplantation.  Dig Dis. 1999;  17 133-144
    CrossrefPubMedGoogle Scholar
  • 27 Todo S, Furukawa H, Kamiyama T. How to prevent and mange biliary complications in living donor liver transplantation?.  Journal of Hepatology. 2005;  43 13-37
    CrossrefPubMedGoogle Scholar
  • 28 Shokouh-Amiri M H, Grewal H P, Vera S R, Stratta R J, Bagous W, Gaber A O. Duct-to-duct biliary reconstruction in right lobe adult living donor liver transplantation.  J Am Coll Surg. 2001;  192 798-803
    CrossrefPubMedGoogle Scholar
  • 29 Grewal H P, Shokouh-Amiri M H, Vera S, Stratta R, Bagous W, Gaber A O. Surgical technique for right lobe adult living donor liver transplantation without venovenous bypass or portocaval shunting and with duct-to-duct biliary reconstruction.  Ann Surg. 2001;  233 502-508
    CrossrefPubMedGoogle Scholar
  • 30 Malago M, Testa G, Hertl M, Lang H, Paul A. et al . Biliary reconstruction following right adult living donor liver transplantation end-to-end or end-to-side duct-to-duct anastomosis.  Langenbecks Arch Surg. 2002;  387 37-44
    CrossrefPubMedGoogle Scholar
  • 31 Kawachi S, Shimazu M, Wakabayashi G. et al . Biliary complications in adult living donor liver transplantation with duct-to-duct hepaticocholedochostomy or Roux-en-Y hepaticojejunostomy biliary reconstruction.  Surgery. 2002;  132 48-56
    CrossrefPubMedGoogle Scholar
  • 32 Ishiko T, Egawa H, Kasahara M. et al . Duct-to-duct biliary reconstruction in living donor liver transplantation utilizing right lobe graft.  Ann Surg. 2002;  236 235-240
    CrossrefPubMedGoogle Scholar
  • 33 Liu C L, Lo C M, Chan S C, Tso W K, Fan S T. The right may not be always right: biliary anatomy contraindicates right lobe live donor liver transplantation.  Liver Transpl. 2004;  10 811-812
    CrossrefPubMedGoogle Scholar
  • 34 Dulundu E, Sugawara Y, Sano K. et al . Duct-to-duct biliary reconstruction in adult living-donor liver transplantation.  Transplantation. 2004;  78 574-579
    PubMedGoogle Scholar
  • 35 Testa G, Malago M, Broelseh C E. Complications of biliary tract in liver transplantation.  World J Surg. 2001;  5 1296-1299
    PubMedGoogle Scholar
  • 36 Choi J W, Kim T K, Kim K W, Kim A Y, Kim P N, Ha H K, Lee M G. Anatomic variation in intrahepatic bile ducts: an analysis of intraoperative cholangiograms in 300 consecutive donors for living donor liver transplantation.  Korean J Radiol. 2003;  4 85-90
    PubMedGoogle Scholar
  • 37 Marcos A. Right lobe living donor liver transplantation: a review.  Liver Transpl. 2000;  6 3-20
    PubMedGoogle Scholar
  • 38 Fan S T, Lo C M, Liu C L, Tso W K, Wong J. Biliary reconstruction and complications of right lobe live donor liver transplantation.  Ann Surg. 2002;  236 676-683
    CrossrefPubMedGoogle Scholar
  • 39 Lee K W, Joh J W, Kim S J. et al . High hilar dissection: new technique to reduce biliary complication in living donor liver transplantation.  Liver Transpl. 2004;  10 1158-1162
    CrossrefPubMedGoogle Scholar
  • 40 Gondolesi G E, Varotti G, Florman S S. et al . Biliary complications in 96 consecutive right lobe living donor transplant recipients.  Transplantation. 2004;  77 1842-1848
    CrossrefPubMedGoogle Scholar
  • 41 Yazumi S, Yoshimoto T, Hisatsune H. et al . Endoscopic treatment of biliary complications after right-lobe living-donor liver transplantation with duct-to-duct biliary anastomosis.  J Hepatobiliary Pancreat Surg. 2006;  13 502-510
    CrossrefPubMedGoogle Scholar
  • 42 Settmacher U, Steinmüller T, Schmidt S C. et al . Technique of bile duct reconstruction and management of biliary complications in right lobe living donor liver transplantation.  Clin Transplant. 2003;  17 37-42
    CrossrefPubMedGoogle Scholar
  • 43 Kasahara M, Egawa H, Takada Y. et al . Biliary reconstruction in right lobe living-donor liver transplantation: Comparison of different techniques in 321 recipients.  Ann Surg. 2006;  243 559-566
    CrossrefPubMedGoogle Scholar
  • 44 Yi N J, Suh K S, Cho J Y, Kwon C H, Lee K U. In adult-to-adult living donor liver transplantation hepaticojejunostomy shows a better long-term outcome than duct-to-duct anastomosis.  Transpl Int. 2005;  18 1240-1247
    CrossrefPubMedGoogle Scholar
  • 45 Moser M A, Wall W J. Management of biliary problems after liver transplantation.  Liver Transpl. 2001;  7 S 46-S 52
    PubMedGoogle Scholar
  • 46 Thuluvath P J, Pfau P R, Kimmey M B, Ginsberg G G. Biliary complications after liver transplantation: the role of endoscopy.  Endoscopy. 2005;  37 857-863
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Sheng R, Sammon J K, Zajko A B, Campbell W L. Bile leak after hepatic transplantation: cholangiographic features, prevalence, and clinical outcome.  Radiology. 1994;  192 413-416
    CrossrefPubMedGoogle Scholar
  • 48 Verran D J, Asfar S K, Ghent C N, Grant D R, Wall W J. Biliary reconstruction without T tubes or stents in liver transplantation: report of 502 consecutive cases.  Liver Transpl Surg. 1997;  3 365-373
    PubMedGoogle Scholar
  • 49 Pfau P R, Kochman M L, Lewis J D. et al . Endoscopic management of postoperative biliary complications in orthotopic liver transplantation.  Gastrointest Endosc. 2000;  52 55-63
    CrossrefPubMedGoogle Scholar
  • 50 Thuluvath P J, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation.  Liver Int. 2003;  23 156-162
    CrossrefPubMedGoogle Scholar
  • 51 O’Connor T P, Lewis W D, Jenkins R L. Biliary tract complications after liver transplantation.  Arch Surg. 1995;  130 312-317
    PubMedGoogle Scholar
  • 52 Shuhart M C, Kowdley K V, McVicar J P. et al . Predictors of bile leaks after T-tube removal in orthotopic liver transplant recipients.  Liver Transpl Surg. 1998;  4 62-70
    CrossrefPubMedGoogle Scholar
  • 53 Johnston T D, Gates R, Reddy K S, Nickl N J, Ranjan D. Nonoperative management of bile leaks following liver transplantation.  Clin Transplant. 2000;  14 365-369
    CrossrefPubMedGoogle Scholar
  • 54 Graziadei I W, Schwaighofer H, Koch R. et al . Long-term outcome of endoscopic treatment of biliary strictures after liver transplantation.  Liver Transpl. 2006;  12 718-725
    CrossrefPubMedGoogle Scholar
  • 55 Porayko M K, Kondo M, Steers J L. Liver transplantation: late complications of the biliary tract and their management.  Semin Liver Dis. 1995;  15 139-155
    PubMedGoogle Scholar
  • 56 Schlitt H J, Meier P N, Nashan B. et al . Reconstructive surgery for ischemic-type lesions at the bile duct bifurcation after liver transplantation.  Ann Surg. 1999;  229 137-145
    CrossrefPubMedGoogle Scholar
  • 57 Rizk R S, McVicar J P, Emond M J. et al . Endoscopic management of biliary strictures in liver transplant recipients: effect on patient and graft survival.  Gastrointest Endosc. 1998;  47 128-135
    CrossrefPubMedGoogle Scholar
  • 58 Capussotti L, Ferrero A, Vigano L, Sgotto E, Muratore A, Polastri R. Bile leakage and liver resection: Where is the risk?.  Arch Surg. 2006;  141 690-694
    CrossrefPubMedGoogle Scholar
  • 59 Lo C M, Fan S T, Liu C L, Lai E C, Wong J. Biliary complications after hepatic resection: risk factors, management, and outcome.  Arch Surg. 1998;  133 156-161
    CrossrefPubMedGoogle Scholar
  • 60 Yamashita Y, Hamatsu T, Rikimaru T. et al . Bile leakage after hepatic resection.  Ann Surg. 2001;  233 45-50
    CrossrefPubMedGoogle Scholar
  • 61 Ernst O, Sergent G, Mizrahi D, Delemazure O, L'Hermine C. Biliary leaks: treatment by means of percutaneous transhepatic biliary drainage.  Radiology. 1999;  211 345-348
    CrossrefPubMedGoogle Scholar
  • 62 Ito T, Kiuchi T, Egawa H. et al . Surgery-related morbidity in living donors of right-lobe liver graft: lessons from the first 200 cases.  Transplantation. 2003;  76 158-163
    PubMedGoogle Scholar
  • 63 Hisatsune H, Yazumi S, Egawa H. et al . Endoscopic management of biliary strictures after duct-to-duct biliary reconstruction in right-lobe living-donor liver transplantation.  Transplantation. 2003;  76 810-815
    PubMedGoogle Scholar

S.-C. Schmidt

Charité Campus Virchow Klinikum · Klinik für Allgemein-, Visceral- und Transplantationschirurgie · Universitätsmedizin Berlin

Augustenburger Platz 1

13353 Berlin

Germany

Phone: +49/30/4 50 65 21 16

Fax: +49/30/4 50 55 29 00

Email: sven.schmidt@charite.de

      >