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Einfluss der Gallengangsanatomie auf biliäre Komplikationen bei Lebendspenden des rechten Leberlappens

Influence of bile duct anatomy on biliary complications in hepatic right lobe living donors

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Zusammenfassung

Die perioperative Morbidität bei Lebendspenden einer Teilleber entsteht hauptsächlich durch Infektionen und biliäre Komplikationen. Varianten der Gallengangsanatomie, insbesondere des rechten Systems, werden hier als Ursache mitvermutet. Wir untersuchten bei Spenden des rechten Leberlappens, welchen Einfluss die Varianten der Gallengangsanatomie auf die Inzidenz von biliären Spenderkomplikationen haben. Dazu wurden 103 Spenden analysiert. Bei 12 Patienten bestanden therapiebedürftige Gallelecks, die alle endoskopisch folgenlos zur Ausheilung gebracht wurden. Eine zentrale, extrahepatische Gallengangsläsion Nagano Typ C sahen wir nicht. Die anatomische Variante Huang A3 ist die operationstechnisch anspruchsvolle anatomische Variante. Bei 3/17 Patienten mit einer biliären Anatomie Huang A3 traten Leckagen auf. Die Gallengangsanatomie kann durch Magnetresonanz-Cholangiopankreatikographie und intraoperative Cholangiographie sorgfältig evaluiert werden.

Der anatomischen Variante Huang A3 sollte besondere Aufmerksamkeit beim Verschluss der Gallengangsostien gewidmet werden.

Abstract

Perioperative morbidity in the living donation of partial livers is mainly due to infections and biliary complications. Bile duct anatomy variants, in particular of the right system, are suspected to be causative. We investigated the influence of bile duct variants on the incidence of biliary donor complications in donations of the right liver lobe. We analyzed 103 donors. Twelve patients had a bile leak that required treatment. All of these were treated endoscopically without any residual defect. We did not see a central extrahepatic bile duct lesion Nagano type C. The anatomic variant Huang A3 is a challenge with respect to the surgical technique. Three of 17 patients with biliary anatomy Huang A3 developed leaks. The bile duct anatomy can be carefully evaluated by magnetic resonance cholangiopancreatography (MRCP) and intraoperative cholangiography. The anatomic variant Huang A3 warrants particular attention for the closure of the bile duct orifice.

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  1. Klinik für Allgemein‑, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland

    A. Bauschke, A. Altendorf-Hofmann, C. Malessa, O. Rohland & U. Settmacher

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Bauschke, A., Altendorf-Hofmann, A., Malessa, C. et al. Einfluss der Gallengangsanatomie auf biliäre Komplikationen bei Lebendspenden des rechten Leberlappens. Chirurg 89, 222–228 (2018). https://doi.org/10.1007/s00104-017-0514-0

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