Gallengangsprobleme in der Leberchirurgie und Lebertransplantation

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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 9 Lo C M, Shaked A, Busuttil R W. Risk factors for liver transplantation across the ABO barrier.  Transplantation. 1994;  15 543-547
• 10 Ascher H L. Liver transplantation - the first 25 years.  West J Med. 1988;  149 316-321
• 11 Buckels J AC. Liver transplantation. In: Forsythe JLR (Hrsg.). Saunders, London 1997; 165
• 12 Lerut J, Gordon R D, Iwatsuki S. et al . Biliary tract complications in human orthotopic liver transplantation.  Transplantation. 1987;  43 47-51
• 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
• 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
• 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
• 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
• 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
• 18 Thethy S, Thomson B NJ, Pleass H. et al . Management of biliary tract complications after orthotopic livertransplantation.  Clin Transplant. 2004;  18 647-653
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 26 Tung B Y, Kimmey M B. Biliary complications of orthotopic liver transplantation.  Dig Dis. 1999;  17 133-144
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 35 Testa G, Malago M, Broelseh C E. Complications of biliary tract in liver transplantation.  World J Surg. 2001;  5 1296-1299
• 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
• 37 Marcos A. Right lobe living donor liver transplantation: a review.  Liver Transpl. 2000;  6 3-20
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 45 Moser M A, Wall W J. Management of biliary problems after liver transplantation.  Liver Transpl. 2001;  7 S 46-S 52
• 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
• 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
• 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
• 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
• 50 Thuluvath P J, Atassi T, Lee J. An endoscopic approach to biliary complications following orthotopic liver transplantation.  Liver Int. 2003;  23 156-162
• 51 O’Connor T P, Lewis W D, Jenkins R L. Biliary tract complications after liver transplantation.  Arch Surg. 1995;  130 312-317
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 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
• 60 Yamashita Y, Hamatsu T, Rikimaru T. et al . Bile leakage after hepatic resection.  Ann Surg. 2001;  233 45-50
• 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
• 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
• 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