Publications (29) View all
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Article: Hepatobiliäre Anastomosentechniken
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ABSTRACT: Der Erfolg hepatobiliärer Anastomosen wird beeinflusst von dem Durchmesser des Gallengangs, der Höhenlokalisation im Gallengangssystem, der Durchführung einer Erst- oder Revisionsoperation und von begleitenden Infektionen. Die exakte präoperative Diagnostik der Gallenwegsanatomie ist für eine komplikationsarme Gallenwegschirurgie unabdingbar. Hinsichtlich der ableitenden rekonstruktiven Verfahren hat sich zusammenfassend die Hepatikojejunostomie als Standard durchgesetzt. Hierbei wird die biliodigestive Anastomose oberhalb des Zystikusabgangs und ca. 2–3cm unterhalb der Hepatikusgabel angelegt. End-zu-End-Anastomosen des Gallengangs sind im Allgemeinen aufgrund der hohen Stenoseraten nicht zu empfehlen. Präparationen im Leberhilus erfordern eine eindeutige Darstellung aller tubulären Strukturen. Operationen am Ductus hepaticus oder an einzelnen Segmentgallengängen sollten wegen möglicher perioperativer Komplikationen in spezialisierten Zentren durchgeführt werden. Zu den Drainageverfahren in der Gallenwegschirurgie zählen die perkutane transhepatische Cholangiodrainage, intern-externe Ableitung, interne Ableitung mittels endoskopisch oder operativ eingebrachtem Stent, extern-intern-externe Drainage und die T-Drainage. The success of hepatobiliary anastomoses is influenced by the diameter of the bile duct, the location within the biliary tract, the situation of primary or revision surgery and accompanying infections. The exact preoperative diagnostics of the anatomy of the biliary tract are indispensable for low complication rates. Within reconstructive surgery, hepaticojejunostomy has been established as the standard technique and a biliodigestive anastomosis is performed proximal to the cystic duct and 2–3cm below the fork in the hepatic duct. In general, end-to-end anastomoses of the common bile duct are not recommended due to the high risk for stenosis. Within the liver hilus an exact preparation of all tubular structures is mandatory. With regard to possible perioperative complications operations on the hepatic duct or segmental bile ducts should be performed in specialized centers. Methods of drainage in hepatobiliary surgery are percutaneous transhepatic cholangiodrainage (PTCD), internal-external drainage, internal drainage with endoscopic or surgically placed stents, external-internal-external drainage and the T-drain. SchlüsselwörterGallenwege–Ductus hepaticus communis–Biliodigestive Anastomose–Hepatikojejunostomie–Drainage KeywordsBiliary tract–Common bile duct–Biliodigestive anastomosis–Hepaticojejunostomy–DrainageDer Chirurg 04/2012; 82(1):7-13. · 0.70 Impact Factor -
Article: Ischemic-type biliary lesions after ortothopic liver transplantation: diagnosis with magnetic resonance cholangiography.
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ABSTRACT: To determine the accuracy of magnetic resonance (MR) cholangiography for detection of ischemic-type biliary lesions (ITBL) following orthotropic liver transplantation (OLT). MR cholangiography was performed in 16 patients with established diagnosis of ITBL following OLT. Two blinded observers reviewed all images in consensus and recorded diagnostic features including presence of intrahepatic and extrahepatic biliary strictures, dilatations, beading, pruning, and filling defects. Sensitivity, specificity, positive predictive value, and accuracy of MR cholangiography were calculated. Final diagnosis was established at endoscopic retrograde cholangiography. MR cholangiography proved to be a valuable tool for the detection of stenoses and dilatations in patients with ITBL following OLT. Sensitivity of the different diagnostic features ranged between 71% and 100%, specificity between 50% and 100%, accuracy between 81% and 100%, and positive predictive value between 87% and 100%. MR cholangiography proved to be an accurate imaging technique to noninvasively detect biliary complications in patients with ITBL after OLT.Transplantation Proceedings 09/2011; 43(7):2660-3. · 1.00 Impact Factor -
Article: [Magnetic resonance cholangiographic (MRCP) features of ischemic-type biliary lesions (ITBL): a case-control study].
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ABSTRACT: To evaluate the spectrum of MR cholangiography (MRCP) features of ischemic-type biliary lesions (ITBL) after orthotopic liver transplantation (OLT). 30 patients (16 m, 14 f) with an average age of 52 years (9 - 69 y) were examined in two 1.5 MR units using breath-hold 2D-SS-FSE-sequences and 3D-MRCP sequences. 20 of the 30 patients had an established ITBL, and the remaining 10 patients were post-OLT controls. MRCPs were evaluated independently by two experienced radiologists that were blinded to the clinical history as well as the results of other imaging modalities. All images were analyzed for the presence of 16 different pathological features. Differences between ITBL patients and controls were analyzed using the Mann-Whitney-U Test. Inter-rater variability was tested using the Cohen's Kappa test. Abnormal findings of bile ducts were seen in all patients. The most common findings were (in percentage for reader 1 / 2) intrahepatic bile duct dilatation (95 % / 95 %) and extrahepatic bile duct stenoses (95 % / 85 %), followed by intrahepatic main duct stenoses (90 % / 95 %) and segmental duct stenoses (85 % / 85 %). Differences between ITBL patients and controls were significant for most of the analyzed features (Mann-Whitney-U test, p < 0.05). For 12 of 16 features, there was substantial or almost perfect agreement (κ = 0.61 - 1.00), for 2 of 16 features moderate agreement (κ = 0.41- 0.60) and for 2 of 16 features fair agreement (κ < 0.40). In patients with ITBL, MR cholangiography reveals characteristic features that may allow differentiation from other biliary complications after liver transplantation.RöFo - Fortschritte auf dem Gebiet der R 06/2011; 183(8):714-20. · 2.76 Impact Factor -
Article: Strategies for diagnosis and treatment of iatrogenic tracheal ruptures.
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ABSTRACT: Management of tracheal ruptures in critically ill patients is challenging. Conservative treatment has been described, but in mechanically ventilated patients with distal tracheal ruptures surgical repair might be inevitable. Strategies for diagnosis and treatment of tracheal ruptures and handling of mechanical ventilation remain to be clarified. Our aim was to comprise a structured diagnostic and treatment protocol for patients suspicious of tracheal injury, including detailed principles of mechanical ventilation and specific indications for conservative or surgical treatment. Patients with tracheal ruptures were compared in accordance to the need of mechanical ventilation and to indication for surgical repair. In patients suffering from tracheal ruptures affecting the whole tracheal wall and with protrusion of mediastinal structures into the lumen surgery was indicated. We compared ventilatory, hemodynamic and clinical parameters between the different patient groups. We report our structured approach in diagnostics and treatment of tracheal ruptures and place special emphasis on respiratory management. Seventeen patients with tracheal rupture were identified. In 8 patients surgical repair was performed 1.8±1.5 days after diagnosis. Previous to surgery, ventilation parameters improved significantly: plateau pressure decreased, percentage of assisted spontaneous breathing increased and compliance improved. Conservative treatment was successful in long-term ventilated patients (13.7±8 days) even when suffering from distal lesions. Invasiveness of mechanical ventilation and obstruction of tracheal lumen might indicate conservative or surgical treatment strategies in long-term ventilated patients suffering from iatrogenic tracheal rupture. Indications for surgical repair remain to be further clarified.Minerva anestesiologica 05/2011; 77(12):1155-66. · 2.66 Impact Factor -
Article: [Hepatobiliary anastomosis techniques].
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ABSTRACT: The success of hepatobiliary anastomoses is influenced by the diameter of the bile duct, the location within the biliary tract, the situation of primary or revision surgery and accompanying infections. The exact preoperative diagnostics of the anatomy of the biliary tract are indispensable for low complication rates. Within reconstructive surgery, hepaticojejunostomy has been established as the standard technique and a biliodigestive anastomosis is performed proximal to the cystic duct and 2-3 cm below the fork in the hepatic duct. In general, end-to-end anastomoses of the common bile duct are not recommended due to the high risk for stenosis. Within the liver hilus an exact preparation of all tubular structures is mandatory. With regard to possible perioperative complications operations on the hepatic duct or segmental bile ducts should be performed in specialized centers. Methods of drainage in hepatobiliary surgery are percutaneous transhepatic cholangiodrainage (PTCD), internal-external drainage, internal drainage with endoscopic or surgically placed stents, external-internal-external drainage and the T-drain.Der Chirurg 01/2011; 82(1):7-10, 12-3. · 0.70 Impact Factor
