- Email: [email protected]
Technical Problems: Biliary
Technical ProbleIlls: Biliary PETER NEUHAUS ANDREAS PASCHER
Epidemiology
930
Pathophysiology 932 Clinical presentation
934
Diagnostic workup 934 Serum chemical markers 934 Abdominal ultrasonography 934 Graft biopsy 934 Cholangiography 934 Computed tomography 935 Hepatobillary scintigraphy 935 Magnetic resonance cholangiography/ cholanglopancreatography 935 Specific biliary complications 936 Bile leaks 936 Early bile leaks 936 Late bile leaks 937 Bile collection/biliary abscesses 937 Biliary strictures 937 Anastomotic strictures 939 Nonanastomotlc strictures 939 Ampullary dysfunction 940 Biliary stones, sludge, and casts 941 Complications related to bilioenteric anastomosis 942 Mucocele 942 Hemobilia 942 Treatment 942 Bile leaks 943 Bile collection/biliary abscesses 944 Anastomotic strictures 944 Nonanastomotic strictures 944
Ampullary dysfunction 947 Biliary stones, sludge, and casts Mucocele 947 Hemobllia 947
947
Complications involving the biliary tract after orthotopic liver transplantation (OLT) have been a common problem since the early beginning of OLT.l As a consequence of the limited deceased donor pool, more OLTs are performed using alternative techniques such as living donor liver transplantation and split-liver transplantation. Approximately 5 % of OLTs are currently conducted as adult-to-adult right lobe liver transplantations. 2 These emerging methods have altered the incidence and characteristics of biliary complications. The most common biliary complications are biliary leaks and strictures. However, there is a wide range of potential biliary complications that can occur after liver transplantation (Table 62-1). Their incidence varies according to the type of graft, type of donor (deceased donor versus living donor), and the type of biliary anastomosis performed. According to the time of onset after OLT, biliary complications may be divided into early and late complications. Approximately two thirds of all biliary complications occur as early complications within the first 3 months after OLT and are a significant source of morbidity and mortality. 3 Early diagnosis and adequate treatment of biliary complications are pivotal for reducing biliary-related morbidity and mortality and for ensuring graft and 929
Epidemiology
930
Pathophysiology 932 Clinical presentation
934
Diagnostic workup 934 Serum chemical markers 934 Abdominal ultrasonography 934 Graft biopsy 934 Cholangiography 934 Computed tomography 935 Hepatobillary scintigraphy 935 Magnetic resonance cholangiography/ cholanglopancreatography 935 Specific biliary complications 936 Bile leaks 936 Early bile leaks 936 Late bile leaks 937 Bile collection/biliary abscesses 937 Biliary strictures 937 Anastomotic strictures 939 Nonanastomotlc strictures 939 Ampullary dysfunction 940 Biliary stones, sludge, and casts 941 Complications related to bilioenteric anastomosis 942 Mucocele 942 Hemobilia 942 Treatment 942 Bile leaks 943 Bile collection/biliary abscesses 944 Anastomotic strictures 944 Nonanastomotic strictures 944
Ampullary dysfunction 947 Biliary stones, sludge, and casts Mucocele 947 Hemobllia 947
947
Complications involving the biliary tract after orthotopic liver transplantation (OLT) have been a common problem since the early beginning of OLT.l As a consequence of the limited deceased donor pool, more OLTs are performed using alternative techniques such as living donor liver transplantation and split-liver transplantation. Approximately 5 % of OLTs are currently conducted as adult-to-adult right lobe liver transplantations. 2 These emerging methods have altered the incidence and characteristics of biliary complications. The most common biliary complications are biliary leaks and strictures. However, there is a wide range of potential biliary complications that can occur after liver transplantation (Table 62-1). Their incidence varies according to the type of graft, type of donor (deceased donor versus living donor), and the type of biliary anastomosis performed. According to the time of onset after OLT, biliary complications may be divided into early and late complications. Approximately two thirds of all biliary complications occur as early complications within the first 3 months after OLT and are a significant source of morbidity and mortality. 3 Early diagnosis and adequate treatment of biliary complications are pivotal for reducing biliary-related morbidity and mortality and for ensuring graft and 929