Alvanos A, Rademacher S, Hoffmeister A, Seehofer D. [Surgical approach to benign bile duct alterations].
Chirurg 2019;
91:11-17. [PMID:
31705282 DOI:
10.1007/s00104-019-01061-1]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND
Benign biliary diseases comprise entities, which present with very similar pathognomonic symptoms despite fundamental etiological differences. Obstructions of intrahepatic and extrahepatic bile ducts due to stones, tumors or parasites as well as stenoses and cystic alterations belong to the group of benign biliary diseases.
OBJECTIVE
This article provides a systematic overview of the indications and differential treatment of benign biliary diseases with special emphasis on the surgical treatment.
MATERIAL AND METHODS
The presented recommendations are in accordance with national and international guidelines, current scientific papers and expert opinions.
RESULTS
Essentially the surgical options for benign biliary diseases consist of revision, reconstruction through bilioenteric anastomosis, resection and complete organ replacement in the sense of liver transplantation. The location of the affected segment of the biliary tree, the symptoms, the progress of the disease and suspected malignancy essentially determine the level of escalation in the described treatment level scheme.
CONCLUSION
The treatment of benign biliary diseases is complex and requires achievement of unimpaired, unobstructed bile drainage. It serves the purpose of resolving cholestasis and thereby avoiding recurrent cholangitis and long-term complications, such as biliary cirrhosis and malignant transformation; however, in some cases of premalignant lesions of the bile ducts the strategy resembles cancer surgery, including resection of the affected tissue.
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