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DOI: 10.1055/a-1857-5775
Endoskopisches Management von Gallengangskomplikationen nach Leberchirurgie
Endoscopic Management of Biliary Complications Following Hepatobiliary Surgery![](https://www.thieme-connect.de/media/zblchir/202204/lookinside/thumbnails/10-1055-a-1857-5775_zbc1784-1.jpg)
Zusammenfassung
Biliäre Komplikationen stellen häufige Komplikationen nach Leberchirurgie dar und tragen wesentlich zur postoperativen Morbidität und Mortalität bei. Den größten Anteil dieser machen Gallengangsleckagen und -strikturen aus, wobei die Leckagen nach Cholezystektomie und Leberresektion dominieren und die Strikturen ein wesentliches Problem nach Lebertransplantationen darstellen. Patienten nach orthotoper Lebertransplantation stellen besonders vulnerable Patienten dar, deren biliäre Komplikationen von denen nach Cholezystektomie und Leberresektion differieren und niederschwellig sowie mit größter Vorsicht behandelt werden müssen. Mit der endoskopischen retrograden Cholangiografie steht ein exzellentes Verfahren zur Behandlung dieser Komplikationen zur Verfügung. Die therapeutischen Möglichkeiten beinhalten die endoskopische Sphinkterotomie, die Anlage von Prothesen und Dilatationen. Mittels dieser Verfahren können Erfolgsraten in bis zu 90% der Fälle erreicht werden. Bei Hepatikojejunostomien bestehen alternative Interventionsmöglichkeiten wie die ballon- oder motorunterstützte antegrade Enteroskopie, die perkutan-transhepatische Cholangiodrainage oder mit zunehmendem Einsatz die endosonografisch gestützten Verfahren.
Abstract
Biliary complications are frequent after hepatic surgery and may greatly influence postoperative morbidity and mortality. Most of these are leaks or strictures to the bile duct, most frequently leaks after cholecystectomy and liver resection. Strictures are an important problem after liver transplantation. Patients after orthotopic liver transplantation are particularly vulnerable, as they are different from biliary complications after liver resection and must be treated very sensitively and carefully. Endoscopic retrograde cholangiography is an excellent procedure for treating these complications. The therapeutic properties include endoscopic sphincterotomy, insertion of prostheses and dilatations. These procedures can give success rates of up to 90% of cases. For hepatico-jejunostomies, there are alternative possibilities of intervention, such as balloon- or motor-supported antegrade enteroscopy, percutaneous transhepatic cholangio drainage or the increasing use of endosonographically supported procedures.
Publication History
Received: 16 March 2022
Accepted after revision: 17 May 2022
Article published online:
16 August 2022
© 2022. Thieme. All rights reserved.
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