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Biliary Anatomy (biliary + anatomy)
Selected AbstractsL/I-8 Adult living donor liver transplants: biliary morbidityCLINICAL TRANSPLANTATION, Issue 2006A. Giacomoni Introduction:, Biliary problems are very common complications in adult living donor liver transplants (ALDLTs), with a reported negative incidence of 22% to 64%. Patients and methods:, From March 2001 through February 2006, we performed 27 ALDLTs, grafting segments V-VIII without the middle hepatic vein. Biliary anatomy was investigated using intraoperative cholangiography in the first 5 patients and with magnetic resonance cholangiography alone in the remaining 22. In 15 patients, we found a single right biliary duct (55.55%) and in 12 we found multiple biliary ducts (44.45%). We performed single biliary anastomoses in 20 patients (74.07%) and multiple anastomoses in the remaining 7 (25.93%). Results:, With a mean follow-up of 675 days (range, 8 to 1,804 days), patient and graft survival rates were 85% and 74%. The following biliary complications were observed: 4 biliary leaks from the cut surface, 3 anastomotic leaks, 6 late anastomotic strictures, and 1 early kinking of the choledochus. These 14 biliary complications (51.85%) occurred in 11 patients (40.74%). Conclusion:, Biliary complications affected our series of ALDLTs at a high percentage, but none of the grafts transplanted was lost due to biliary problems. Magnetic resonance cholangiography seems to be a reliable instrument to investigate biliary anatomy. Multiple biliary reconstructions are strongly associated with a high risk of complications. [source] Segmental nature of the porcine liver and its potential as a model for experimental partial hepatectomy,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2003F. G. Court Background: In-depth knowledge of pig liver anatomy allows potential research into segmental liver resections and hepatic regeneration, as well as liver transplantation techniques. The segmental anatomy, however, remains largely unknown. This study aimed to delineate the segmental anatomy of the porcine liver in comparison with that of the human. Methods: The segmental anatomy of the porcine liver was determined using acrylic injection casting of ex vivo pig livers, allowing the arterial, venous and biliary supply to be visualized directly. This was correlated using multi-slice computed tomography (CT) and three-dimensional reconstructions. Results: Although the external morphology of the porcine liver differs from that of the human, the segmental anatomy is remarkably similar in term of its vascularity and biliary tree. Conclusion: Acrylic casting of the porcine liver accurately delineates the vascular and biliary anatomy, and is a useful tool for performing experimental liver surgery. The similarities between porcine and human segmental anatomy allow domestic swine to be used as a comparable model. Three-dimensional CT reconstructions can also accurately visualize the anatomy and may be used to perform virtual surgery, or to assess segmental volumes. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Anatomical variations of the extrahepatic biliary tree: Review of the world literatureCLINICAL ANATOMY, Issue 3 2001M. Lamah Abstract The anatomy facing a surgeon during cholecystectomy involves complex relationships between the hepatic artery, extrahepatic biliary tree, and gallbladder. A sound knowledge of the normal anatomy of the extrahepatic biliary tract is thus essential in the prevention of operative injury to it. Equally important, however, is an understanding of congenital variation of biliary and vascular anatomy, as the literature abounds with reports of specific anatomical variations, and their operative implications. This article reviews the world literature on congenital variation of extrahepatic biliary anatomy. Clin. Anat. 14:167,172, 2001. © 2001 Wiley-Liss, Inc. [source] MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complicationsCLINICAL TRANSPLANTATION, Issue 4 2010Piero Boraschi Boraschi P, Donati F, Gigoni R, Volpi A, Salemi S, Filipponi F, Falaschi F. MR cholangiography in orthotopic liver transplantation: sensitivity and specificity in detecting biliary complications. Clin Transplant 2010: 24: E82,E87. © 2009 John Wiley & Sons A/S. Abstract:, Background:, To assess the diagnostic value of magnetic resonance cholangiography (MRC) when evaluating biliary complications in a large series of liver transplants. Methods:, One hundred and twenty-nine patients prospectively underwent magnetic resonance (MR) imaging and MR cholangiography at 1.5-T device after orthotopic liver transplantation (OLT). After the preliminary acquisition of axial T1- and T2-weighted images, MRC involved respiratory-triggered, thin-slab (2 mm), heavily T2-weighted fast spin-echo and breath-hold, thick-slab (10,50 mm), single-shot T2-weighted sequences. MR images were blindly evaluated by two experienced readers in conference to determine the biliary anatomy and the presence of complications, whose final diagnosis was based on endoscopic retrograde cholangiography, percutaneous trans-hepatic cholangiography, and by integrating clinical follow-up with ultrasound and/or MR findings. Results:, Biliary complications were found in 60 patients (46.5%) and were represented by ischemic-type biliary lesions (n = 21); anastomotic strictures (n = 13); non-anastomotic strictures (n = 5); anastomotic strictures associated to lithiasis (n = 6); lithiasis (n = 6); papillary dysfunctions (n = 9). The sensitivity, specificity, positive predictive value, and negative predictive value of the reviewers for the detection of all types of biliary complications in patients with OLT were 98%, 94%, 94%, and 98%, respectively. Conclusions:, MRC is a reliable technique for detecting post-OLT biliary complications and should be recommended before planning therapeutic interventions. [source] L/I-8 Adult living donor liver transplants: biliary morbidityCLINICAL TRANSPLANTATION, Issue 2006A. Giacomoni Introduction:, Biliary problems are very common complications in adult living donor liver transplants (ALDLTs), with a reported negative incidence of 22% to 64%. Patients and methods:, From March 2001 through February 2006, we performed 27 ALDLTs, grafting segments V-VIII without the middle hepatic vein. Biliary anatomy was investigated using intraoperative cholangiography in the first 5 patients and with magnetic resonance cholangiography alone in the remaining 22. In 15 patients, we found a single right biliary duct (55.55%) and in 12 we found multiple biliary ducts (44.45%). We performed single biliary anastomoses in 20 patients (74.07%) and multiple anastomoses in the remaining 7 (25.93%). Results:, With a mean follow-up of 675 days (range, 8 to 1,804 days), patient and graft survival rates were 85% and 74%. The following biliary complications were observed: 4 biliary leaks from the cut surface, 3 anastomotic leaks, 6 late anastomotic strictures, and 1 early kinking of the choledochus. These 14 biliary complications (51.85%) occurred in 11 patients (40.74%). Conclusion:, Biliary complications affected our series of ALDLTs at a high percentage, but none of the grafts transplanted was lost due to biliary problems. Magnetic resonance cholangiography seems to be a reliable instrument to investigate biliary anatomy. Multiple biliary reconstructions are strongly associated with a high risk of complications. [source] L/I-9 Adult living donor liver transplants: Niguarda experience in MilanCLINICAL TRANSPLANTATION, Issue 2006A. Giacomoni Introduction: Adult living donor liver transplants (ALDLTs) have emerged as an option in the last few years. Materials and methods:, From March 2001 through February 2006, we performed 27 ALDLTs. Liver volume, vascular, and biliary anatomy were assessed by CT scan and magnetic resonance cholangiography. The graft-to-recipient weight ratio was always above 0.8. The recipients were United Network for Organ Sharing (UNOS) status 2B or 3. The transplant was carried out grafting segments V-VIII to the recipient without the MHV. In the recipient we have never used a venous-venous bypass. Results:, With a mean follow-up of 675 days (range, 8 to 1,804 days), 23 out of the 27 patients are alive. Three have undergone a retransplant: 2 as a consequence of an arterial thrombosis and 1 because of small-for-size-syndrome. These data show an overall patient and graft survival rate of 85% and 74%. Four deaths were caused by massive pulmonary bleeding due to Rendù-Osler syndrome, systemic aspergillosis, sepsis, and cardiac arrhythmia. Fourteen biliary complications (51.85%) occurred in 11 recipients (40.74%); 3 of these patients developed 2 consecutive and different biliary complications. All the donors are alive and well. Conclusion:, An expert surgical team and proper selection of both donor and recipient are mandatory. Overall results of ALDLTs are very satisfactory, even if we have to take into account a high rate of biliary complications. [source] | ||||||||||