الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Transplantation is one of the greatest achievements of modern medicine with the integration of advances in immunosuppression and surgical techniques. Understanding the anatomy and pathophysiology of the liver and critical care of hepatic patients, all make liver transplantation a widely accepted therapy for patients with end-stage liver disease.
The persistent organ shortage and numerous deaths of patients on the waiting list were the force for the introduction of LDLT.
Duct-to-duct biliary reconstruction is prefered than Roux-en-Y hepaticojujenostomy (RYHJ) as it can preserve the function of the sphincter of Oddi , also it is technically faster and easier than RYHJ.
Biliary complications after liver transplantation continue to be a cause of morbidity and mortality despite advances in surgical techniques, immunosuppression, and postoperative management. The most common complications are bile leaks and anastomotic strictures.
Multiple imaging modalities can be used for diagnosis of biliary complications including ultrasonography, MRCP, ERCP, PTC, isotope scannig, CT cholangiography & endoscopic ultrasound.
In cases with biliary leak, it requires biliary diversion procedures. The role of ERCP consists of determination of the site of the leakage , endoscopic sphincterotomy, stent placement, nasobiliary drainage, or endoscopic nasal biliary drainage combined with stent is selected. PTC is difficult in absence of biliary dilatation & more invasive and painful than ERCP . Internal-external biliary drainage catheter is inserted into the biliary system across the anastomosis to divert the bile away from the leak and maintain biliary drainage into the intestine.
Historically, the management of post-LDLT anastomotic biliary strictures consisted of surgical reconstruction in the form of RYHJ. However, the last decade has seen such tremendous growth in the evolution of endoscopic techniques that they are now considered the treatment of choice for biliary leakage & stricture. Percutaneous therapy, is considered the second-line option because of the invasive nature of the procedure and the associated complications of hemorrhage, bile leaks, and significant morbidity. Surgery is now confined to patients for whom endoscopic modalities have failed and is considered to be the last-line back-up option.
The role of ERCP in cases of anastomotic biliary strictures, consists of identification of the mouth of the stricture followed by cannulation by the guidewire, balloon dilatation of the stricture and subsequent placement of plastic stents. Percutaneous dilatation of the anastomotic stricture is done in cases of failed ERCP or anastomotic stricture complicating a hepaticojejunostomy. Then, internal-external biliary drainage catheter is inserted into the biliary system across the anastomotic stricture .
Non anastomotic strictures are difficult to treat , more resistant to endoscopic treatment and may require retransplantation.