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Biliodigestive Anastomosen

Indikationen, Komplikationen und interdisziplinäres Management

Biliodigestive anastomosis

Indications, complications and interdisciplinary management

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Zusammenfassung

Biliodigestive Anastomosentechniken stellen eine häufige primäre Indikation bei chirurgischen Eingriffen dar und werden darüber hinaus zum Management bei Gallenwegskomplikationen nach primären und sekundären Eingriffen an den Gallenwegen benötigt. Die Evidenz zum Komplikationsmanagement nach Anlage biliodigestiver Anastomosen ist gering. Biliodigestive Anastomosen können als Hepatikojejunostomie, Hepatojejunostomie/Portoenterostomie oder Hepatikoduodenostomie in fortlaufender oder Einzelknopfnahttechnik angelegt werden. Das Komplikationsmanagement und die Indikation zu einer bestimmten Maßnahme sollte in der Hand erfahrener hepatopankreatobiliärer Chirurgen immer im Hinblick auf den Abstand zur primären Operation betrachtet und interdisziplinär operativ und/oder interventionell radiologisch/endoskopisch diskutiert und angegangen werden. Die Therapie kann protrahiert sein und erfordert eine wiederholte kritische Betrachtung der entsprechenden Komplikation.

Abstract

Techniques for biliodigestive anastomoses are a frequent indication in primary surgical interventions. Moreover, they are required to manage secondary complications of hepatobiliary surgery. Evidence for the management of complications following biliodigestive anastomoses is low. Biliodigestive anastomoses can be performed as hepaticojejunostomy, hepatojejunostomy/portoenterostomy and hepaticoduodenostomy using running or single stitch suture techniques. Complication management in the hands of experienced hepatopancreatobiliary surgeons should consider a time delay to the primary operation and an interdisciplinary surgical and/or endoscopic or radiologic interventional approach. The therapy may be protracted and requires repeated critical reflection of the particular complication.

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Authors and Affiliations

  1. Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland

    H. Goessmann, C. Stroszczynski & A.G. Schreyer

  2. Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland

    S.A. Lang, S. Fichtner-Feigl, M.N. Scherer, H.J. Schlitt &  A.A. Schnitzbauer

  3. Zentrum für Chirurgie, Klinik für Allgemein- und Viszeralchirurgie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    A.A. Schnitzbauer

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  1. H. Goessmann
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  2. S.A. Lang
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  3. S. Fichtner-Feigl
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  6. C. Stroszczynski
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Correspondence to A.A. Schnitzbauer.

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Goessmann, H., Lang, S., Fichtner-Feigl, S. et al. Biliodigestive Anastomosen. Chirurg 83, 1097–1108 (2012). https://doi.org/10.1007/s00104-012-2365-z

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  • DOI: https://doi.org/10.1007/s00104-012-2365-z

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