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With the advent of living donor liver transplant, the waiting list mortality of patients needing liver transplant has decreased. However, increased morbidity is observed, including higher rates of biliary complications (BCs). Strictures and postoperative leaks constitute the majority of the BCs. Various factors such as multiple biliary ducts anastomosis and small caliber ducts in the bile ducts increase the risk of biliary strictures. The lack of biliary dilation in the graft livers after liver transplant makes the recognition of biliary complications challenging and the diagnosis relies on abnormal liver function tests. Magnetic resonance cholangiopancreaticography provides a valuable means to assess the biliary anatomy prior to interventions by showing the level of stricture. While endoscopic retrograde cholangiopancreatography is considered the first modality to treat biliary strictures, those patients with proximal strictures and those with complex biliary anatomy with acute angulations between the donor and the recipient show poor response to endoscopic interventions. In such patients, percutaneous biliary interventions have success rates between 70 and 90%. Novel percutaneous biliary intervention techniques such as cholangioscopy-assisted laser incision and magnetic compression anastomosis are used to navigate difficult biliary strictures. Recently, biodegradable stents have been used to treat recalcitrant biliary strictures. In this review, we present the imaging features of common biliary complications following liver transplant and percutaneous biliary interventions in managing these complications.
With the advent of living donor liver transplant, the waiting list mortality of patients needing liver transplant has decreased. However, increased morbidity is observed, including higher rates of biliary complications (BCs). Strictures and postoperative leaks constitute the majority of the BCs. Various factors such as multiple biliary ducts anastomosis and small caliber ducts in the bile ducts increase the risk of biliary strictures. The lack of biliary dilation in the graft livers after liver transplant makes the recognition of biliary complications challenging and the diagnosis relies on abnormal liver function tests. Magnetic resonance cholangiopancreaticography provides a valuable means to assess the biliary anatomy prior to interventions by showing the level of stricture. While endoscopic retrograde cholangiopancreatography is considered the first modality to treat biliary strictures, those patients with proximal strictures and those with complex biliary anatomy with acute angulations between the donor and the recipient show poor response to endoscopic interventions. In such patients, percutaneous biliary interventions have success rates between 70 and 90%. Novel percutaneous biliary intervention techniques such as cholangioscopy-assisted laser incision and magnetic compression anastomosis are used to navigate difficult biliary strictures. Recently, biodegradable stents have been used to treat recalcitrant biliary strictures. In this review, we present the imaging features of common biliary complications following liver transplant and percutaneous biliary interventions in managing these complications.
Background The porcine gall bladder and cystic duct gained attention in experimental research aimed at improving human clinical care. While the common bile duct has been investigated before, there is almost no data on the porcine cystic duct. Its relevance for research originates from its potential use in xenotransplantation. Methods We included 10 consecutive pigs (1♀, 9♂) that had been sacrificed after participation in another study. At necropsy, the distance from the biliary papilla to the gall bladder (gall bladder distance) was measured. The cystic duct was then subjected to linear traction. Ethical approval for the study was granted. Associations between force measurements and anatomical parameters were tested by correlation analysis. Results The pigs had a mean body weight of 21.9 kg (standard deviation 2 kg), a mean liver weight of 590 g (standard deviation 88 g), and a mean crown rump length of 67.3 cm (standard deviation 3 cm). The gall bladder distance was 8.2 cm (95% confidence interval: 7.6–8.7 cm). The cystic duct withstood mean linear traction forces of 4.8 N (95% confidence interval: 3.7–5.8 N) and could be elongated by a mean of 6 mm (95% confidence interval: 3.9–8 mm). Linear breaking strength was neither correlated to gall bladder distance (R = 0.3, 95% confidence interval: − 0.41 to 0.78, P = 0.406) or crown rump length (R = 0.42, 95% confidence interval: − 0.28 to 0.83, P = 0.222) nor liver weight (R = 0.02, 95% confidence interval: − 0.62 to 0.64, P = 0.954) or body weight (R = 0.36, 95% confidence interval: − 0.35 to 0.81, P = 0.304). This was also true for gall bladder distance. Conclusions Our study indicates that allometric parameters were not associated with the gall bladder distance or its resistance to traction forces. Consequently, substantial variation of these parameters can be expected in these surgically important parameters, which cannot be derived from easily accessible anatomical parameters.
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