Summary
In hepatic transplantation complications of the biliary drainage were frequently observed. Ischemia of the extrahepatic bile duct which occurs for anatomical reasons can cause necrosis of the bile duct. The reconstruction of biliary drainage by biliodigestive anastomosis results in ascending infections of the graft. Biliary sludge could obstruct the intra- or extrahepatic bile duct. Recently, operation methods are mainly applied in which the function of Oddi's sphincter is preserved, i. e. choledocho-choledochostomy or gallbladder conduit method. If it is not possible to perform these methods the Roux-y jejunum loop is used. Finally, an immediate operative revision of the biliary drainage is indicated if its complication is diagnosed.
Zusammenfassung
Komplikationen bei der Gallenwegsrekonstruktion treten nach der Lebertransplantation häufig auf. Eine anatomisch bedingte unzureichende Blutversorgung der extrahepatischen Gallenwege führt postoperativ zur Gallengangsnekrose. Biliodigestive Anastomosen haben ein erhöhtes Risiko für ascendierende Infektionen im Transplantat. Gallensludgebildung verursacht eine intra- und extrahepatische Gallenwegsobstruktion. Heute werden hauptsächlich die Sphincterfunktion erhaltende Methoden zur Gallendrainage angewandt, entweder Choledocho-Choledochostomie oder Gallenblasen-Conduit-Methode. Falls dies anatomisch nicht möglich ist, verwendet man eine biliodigestive Anastomose mit einer ausgeschalteten Jejunumschlinge nach Roux. Wird eine Gallenwegskomplikation festgestellt, ist die sofortige operative Revision der Gallendrainage lebensrettend.
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Literatur
Calne RY (1976) 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 184:605
Calne RY, McMaster P, Portmann B, Wall WJ, Williams R (1977) Observations on preservation, bile drainage and rejection in 64 human orthotopic liver allografts. Ann Surg 186:282
Calne RY (1983) Liver transplantation. Grune and Stratton, London
Daloze P, Fourtanier G, Beaudouin M, Corman J, Smeesters C, Saric J (1977) Biliary function after liver transplantation. Transplant Proc 9:309
Krom RAF, Kingma LM, Wesenhagen H, Slooff MJH, Haagsma EB, Gips CH (1984) Choledochocholedochostomy is successful in orthotopic liver transplantation. Transplant Proc 16:1228
Lie TS, Höfer M, Höhnke Ch, Krizek L, Kühnen E, Iwantscheff A, Köster O, Overlack A, Vogel J, Rommelsheim K (1986) Aspergillose nach Lebertransplantation als Hospitalismusinfektion. Dtsch Med Wochenschr (im Druck)
Martineau G, Porter KA, Corman J, Launois B, Schroter GT, Palmer W, Putnam CW, Groth CG, Halgrimson CG, Penn I, Starzl TE (1972) Delayed biliary duct obstruction after orthotopic liver transplantation. Surgery 72:604
McMaster P, Herbertson BM, Cusick C, Calne RY, Syrakos T, Marni A (1979) The development of biliary sludge following liver transplantation. Transplant Proc 11:262
Neuhaus P, Neuhaus R, Pichlmayr R, Vonnahme F (1982) An alternative technique of biliary reconstruction after liver transplantation. Res Exp Med 180:239
Northover JMA, Hickman R, Watson RGK, Terblanche J (1985) Healing of the bile duct anastomosis after transverse choledochotomy or transplantation of the liver in the pig. Surg Gynecol Obstet 160:33
Parke WW, Michels NA, Ghosh GM (1963) Blood supply of the common bile duct. Surg Gynecol Obstet 117:47
Pichlmayr R, Brolsch Ch, Wonigeit K, Neuhaus P, Siegismund S, Schmidt FW, Burdelski M (1984) Experiences with liver transplantation in Hannover. Hepatology 4:56S
Rolles K, Williams R, Neuberger J, Calne RY (1984) The Cambridge and King's College Hospital experience of liver transplantation 1968–1983. Hepatology 4:50S
Schröter GPJ, Hoelscher M, Putnam CW, Porter KA, Hansbrough JF, Starzl TE (1976) Infections complicating orthotopic liver transplantation. Arch Surg 111:1337
Starzl TE, Putnam CW (1969) Experience in hepatic transplantation. Saunders, Philadelphia
Starzl TE, Ishikawa M, Putnam CW, Porter KA, Picache R, Husberg BS, Halgrimson CG, Schroter G (1974) Progress in and deterrents to orthotopic liver transplantation, with special reference to survival, resistance to hyperacute rejection, and biliary duct reconstruction. Transplant Proc 6:129
Starzl TE, Porter KA, Putnam CW, Schroter GPJ, Halgrimson CG, Weil III R, Hoelscher M, Reid HAS (1976) Orthotopic liver transplantation in ninety-three patients. Surg Gynecol Obstet 142:487
Starzl TE, Putnam CW, Hansbrough JF, Porter KA, Reid HAS, Path MRC (1977) Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair. Surgery 81:212
Starzl TE, Iwatsuki S, Shaw BW, Gordon RD (1985) Orthotopic liver transplantation in 1984. Transplant Proc 17:250
Waldram R, Williams R, Caine RY (1975) Bile composition and bile cast formation after transplantation of the liver in man. Transplantation 19:382
Wolff H, Otto G, David H (1985) Biliary tract reconstruction in liver transplantation. Transplant Proc 17:274
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Höfer, M., Höhnke, C., Lee, K.S. et al. Probleme der Rekonstruktion des Gallenabflusses bei der orthotopen Lebertransplantation. Langenbecks Arch Chiv 371, 49–58 (1987). https://doi.org/10.1007/BF01259243
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DOI: https://doi.org/10.1007/BF01259243