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Der Chirurg

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Gallenwegschirurgie im Kindesalter

  • M. DübbersEmail author
Leitthema
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Zusammenfassung

Während Gallensteine im Kindes- und Jugendalter immer häufiger diagnostiziert werden, sind angeborene oder perinatal erworbene Malformationen der Gallenwege seltene Entitäten. Die operative Behandlung dieser Erkrankungen stellt dabei häufig eine technische Herausforderung dar. Bei Kindern mit Gallengangsatresie ist die Portoenterostomie nach Kasai eine therapeutische Option für die ersten Lebenswochen. Die meisten Betroffenen benötigen jedoch bis zum Eintritt in das Erwachsenenalter eine Lebertransplantation. Segmentale Erweiterungen des Ductus choledochus bergen das Risiko aszendierender Infektionen und die Gefahr einer malignen Entartung. Dies erfordert eine frühzeitige Resektion der Gallenwege und die Rekonstruktion mittels biliodigestiver Anastomose. Während die laparoskopische Cholezystektomie auch bei Kindern heutzutage als Standardverfahren gilt, ist der Stellenwert minimal-invasiver Verfahren bei komplexen Gallenwegseingriffen im Kindesalter unklar.

Schlüsselwörter

Angeborene Fehlbildungen Gallengangsatresie Portoenterostomie Choledochuszyste Laparoskopische Chirurgie 

Biliary tract surgery in childhood

Abstract

In contrast to gallstones, which are increasingly diagnosed in children and adolescents, congenital or perinatally acquired malformations of the biliary tree are rare entities. The surgical treatment of these diseases frequently represents a technical challenge. For children with biliary atresia Kasai portoenterostomy is a therapeutic option in the first weeks of life. Most affected children, however, require a liver transplantation before they enter adulthood. Segmental dilatations of the bile duct carry the risk of ascending infections and malignant transformation. This requires early resection of the biliary tree and reconstruction with a bilioenteric anastomosis. While laparoscopic cholecystectomy has become the standard approach also for children, the value of minimally invasive procedures for more complex surgical procedures of the biliary tract has not yet been defined.

Keywords

Congenital malformations Biliary atresia Portoenterostomy Choledochal cyst Laparoscopic surgery 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Dübbers gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Bing L, Wei-bing C, Xia H et al (2019) Modifications to expose porta hepatis for laparoscopic portoenterostomy easier in biliary atresia. J Surg Res 233:368–375.  https://doi.org/10.1016/j.jss.2018.08.013 CrossRefPubMedGoogle Scholar
  2. 2.
    Chan KWE, Lee KH, Wong HYV et al (2014) From laparoscopic to open Kasai portoenterostomy: the outcome after reintroduction of open Kasai portoenterostomy in infant with biliary atresia. Pediatr Surg Int 30:605–608.  https://doi.org/10.1007/s00383-014-3499-5 CrossRefPubMedGoogle Scholar
  3. 3.
    Davenport M (2018) Biliary atresia. In: Losty P, Flake A, Rintala R et al (Hrsg) Rickham’s neonatal surgery. Springer, London, S 848–849Google Scholar
  4. 4.
    Diao M, Li L, Cheng W (2011) Laparoscopic versus Open Roux-en‑Y hepatojejunostomy for children with choledochal cysts: intermediate-term follow-up results. Surg Endosc 25:1567–1573.  https://doi.org/10.1007/s00464-010-1435-x CrossRefPubMedGoogle Scholar
  5. 5.
    Diao M, Li L, Zhang J‑Z, Cheng W (2010) A shorter loop in Roux‑Y hepatojejunostomy reconstruction for choledochal cysts is equally effective: preliminary results of a prospective randomized study. J Pediatr Surg 45:845–847.  https://doi.org/10.1016/j.jpedsurg.2009.12.022 CrossRefPubMedGoogle Scholar
  6. 6.
    Esteves E, Clemente Neto E, Ottaiano Neto M et al (2002) Laparoscopic Kasai portoenterostomy for biliary atresia. Pediatr Surg Int 18:737–740.  https://doi.org/10.1007/s00383-002-0791-6 CrossRefPubMedGoogle Scholar
  7. 7.
    Farello GA, Cerofolini A, Rebonato M et al (1995) Congenital choledochal cyst: video-guided laparoscopic treatment. Surg Laparosc Endosc 5:354–358PubMedGoogle Scholar
  8. 8.
    Grisotti G, Cowles RA (2016) Complications in pediatric hepatobiliary surgery. Semin Pediatr Surg 25:388–394.  https://doi.org/10.1053/j.sempedsurg.2016.10.004 CrossRefPubMedGoogle Scholar
  9. 9.
    Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713.  https://doi.org/10.1016/S0140-6736(09)60946-6 CrossRefGoogle Scholar
  10. 10.
    Hashimoto T, Otobe Y, Shimizu Y et al (1997) A modification of hepatic portoenterostomy (Kasai operation) for biliary atresia. J Am Coll Surg 185:548–553.  https://doi.org/10.1016/S1072-7515(97)00104-X CrossRefPubMedGoogle Scholar
  11. 11.
    Hill R, Parsons C, Farrant P et al (2011) Intrahepatic duct dilatation in type 4 choledochal malformation: pressure-related, postoperative resolution. J Pediatr Surg 46:299–303.  https://doi.org/10.1016/j.jpedsurg.2010.11.008 CrossRefPubMedGoogle Scholar
  12. 12.
    ten Hove A, de Meijer VE, Hulscher JBF, de Kleine RHJ (2018) Meta-analysis of risk of developing malignancy in congenital choledochal malformation. Br J Surg 105:482–490.  https://doi.org/10.1002/bjs.10798 CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Jung E, Park W‑H, Choi S‑O (2011) Late complications and current status of long-term survivals over 10 years after Kasai portoenterostomy. J Korean Surg Soc 81:271–275.  https://doi.org/10.4174/jkss.2011.81.4.271 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Law R, Topazian M (2014) Diagnosis and treatment of choledochoceles. Clin Gastroenterol Hepatol 12:196–203.  https://doi.org/10.1016/j.cgh.2013.04.037 CrossRefPubMedGoogle Scholar
  15. 15.
    Li Y, Gan J, Wang C et al (2019) Comparison of laparoscopic portoenterostomy and open portoenterostomy for the treatment of biliary atresia. Surg Endosc.  https://doi.org/10.1007/s00464-019-06905-9 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Liem NT, Pham HD, Dung LA et al (2012) Early and intermediate outcomes of laparoscopic surgery for choledochal cysts with 400 patients. J Laparoendosc Adv Surg Tech A 22:599–603.  https://doi.org/10.1089/lap.2012.0018 CrossRefPubMedGoogle Scholar
  17. 17.
    Mah D, Wales P, Njere I et al (2004) Management of suspected common bile duct stones in children: role of selective intraoperative cholangiogram and endoscopic retrograde cholangiopancreatography. J Pediatr Surg 39:808–812.  https://doi.org/10.1016/j.jpedsurg.2004.02.019 CrossRefPubMedGoogle Scholar
  18. 18.
    Martin B, Ong EGP (2018) Selective intraoperative cholangiography during laparoscopic cholecystectomy in children is justified. J Pediatr Surg 53:270–273.  https://doi.org/10.1016/j.jpedsurg.2017.11.017 CrossRefPubMedGoogle Scholar
  19. 19.
    Mukhopadhyay B, Shukla RM, Mukhopadhyay M et al (2011) Choledochal cyst: a review of 79 cases and the role of hepaticodochoduodenostomy. J Indian Assoc Pediatr Surg 16:54–57.  https://doi.org/10.4103/0971-9261.78131 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Narayanan SK, Chen Y, Narasimhan KL, Cohen RC (2013) Hepaticoduodenostomy versus hepaticojejunostomy after resection of choledochal cyst: a systematic review and meta-analysis. J Pediatr Surg 48:2336–2342.  https://doi.org/10.1016/j.jpedsurg.2013.07.020 CrossRefPubMedGoogle Scholar
  21. 21.
    Petersen C (2013) Erkrankungen der Leber und Gallenwege. In: von Schweinitz D, Ure B (Hrsg) Kinderchirurgie, Viszerale und allgemeine Chirurgie des Kindesalters. Springer, Berlin Heidelberg, S 515Google Scholar
  22. 22.
    Rosen JD, Lane RS, Martinez JM et al (2017) Success and safety of endoscopic retrograde cholangiopancreatography in children. J Pediatr Surg 52:1148–1151.  https://doi.org/10.1016/j.jpedsurg.2017.01.051 CrossRefPubMedGoogle Scholar
  23. 23.
    Santore MT, Behar BJ, Blinman TA et al (2011) Hepaticoduodenostomy vs hepaticojejunostomy for reconstruction after resection of choledochal cyst. J Pediatr Surg 46:209–213.  https://doi.org/10.1016/j.jpedsurg.2010.09.092 CrossRefPubMedGoogle Scholar
  24. 24.
    Suzuki T, Hashimoto T, Kondo S et al (2010) Evaluating patients’ outcome post-Kasai operation: a 19-year experience with modification of the hepatic portoenterostomy and applying a novel steroid therapy regimen. Pediatr Surg Int 26:825–830.  https://doi.org/10.1007/s00383-010-2637-y CrossRefPubMedGoogle Scholar
  25. 25.
    Todani T, Watanabe Y, Narusue M et al (1977) Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 134:263–269.  https://doi.org/10.1016/0002-9610(77)90359-2 CrossRefPubMedGoogle Scholar
  26. 26.
    Todani T, Watanabe Y, Toki A, Urushihara N (1987) Carcinoma related to choledochal cysts with internal drainage operations. Surg Gynecol Obstet 164:61–64PubMedGoogle Scholar
  27. 27.
    Ure B, Kuebler J, Schukfeh N et al (2011) Survival with the native liver after laparoscopic versus conventional Kasai portoenterostomy in infants with biliary atresia: a prospective trial. Ann Surg 253:826–830.  https://doi.org/10.1097/SLA.0b013e318211d7d8 CrossRefPubMedGoogle Scholar
  28. 28.
    Urushihara N, Fukumoto K, Fukuzawa H et al (2012) Long-term outcomes after excision of choledochal cysts in a single institution: operative procedures and late complications. J Pediatr Surg 47:2169–2174.  https://doi.org/10.1016/j.jpedsurg.2012.09.001 CrossRefPubMedGoogle Scholar
  29. 29.
    Zhen C, Xia Z, Long L et al (2015) Laparoscopic excision versus open excision for the treatment of choledochal cysts: a systematic review and meta-analysis. Int Surg 100:115–122.  https://doi.org/10.9738/INTSURG-D-14-00165.1 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Ziegler K, Pitt H, Zyromski N et al (2010) Choledochoceles: are they choledochal cysts? Ann Surg 252:683–690.  https://doi.org/10.1097/SLA.0b013e3181f6931f CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Schwerpunkt Kinderchirurgie, Klinik für Allgemein‑, Viszeral- und TumorchirurgieUniklinik KölnKölnDeutschland

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