Symptomatic cholecystolithiasis as a rare late biliary complication 16 years after orthotopic liver transplantation, suc
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Symptomatic Cholecystolithiasis as a Rare Late Biliary Complication 16 Years After Orthotopic Liver Transplantation, Successfully Treated with Laparoscopic Cholecystectomy Case Report S. Vernadakis, G. C. Sotiropoulos, G. M. Kaiser, E. Christodoulou, S. Kykalos, B. Juntermanns, Z. Mathe, F. Weber, A. Paul, J. W. Treckmann Received 28/01/2011 Accepted 21/03/2011
Abstract
Liver transplantation, Cholecystolithiasis, Laparoscopy.
bladder of the donor that was in turn transplanted with the liver-graft. The reasoning was that it would allow procedures such as cholecystojejunostomy or donor gallbladder conduit for biliary tract reconstruction to be performed after post-transplant biliary complications [5, 12-14]. Although laparoscopic cholecystectomy is not contraindicated after upper abdominal surgery, it is associated with an increased need for adhesiolysis, a higher conversion rate to open surgery, prolonged operating time, an increased incidence of postoperative wound infections and a longer postoperative stay [14-19]. To the best of our knowledge, this is the first reported case in the world literature of a successful laparoscopic cholecystectomy after liver transplantation.
Introduction
Case Report
Orthotopic liver transplantation (LT) has established its role as the optimum treatment for endstage liver disease and selected cases of hepatocellular carcinoma. Although biliary stones and sludge are relatively common after LT, cholecystolithiasis has not yet been reported. We present the case of post-LT symptomatic cholecystolithiasis, which was successfully treated with laparoscopic cholecystectomy. The incidence of biliary complications after LT and the role of laparoscopy after prior upper abdominal operations are further discussed.
Key words:
Liver transplantation is the therapy of choice for many patients with end-stage liver disease, liver cancer, fulminant hepatic failure and metabolic liver diseases. Biliary complications are a common cause of morbidity following orthotopic liver transplantation (LT). Complications involving the biliary tree usually occur within the first 3 months after transplantation and can be observed in up to 34% of patients [1-6]. While bile leaks and biliary strictures are the most common biliary complications, others such as sphincter of Oddi dysfunction, biliary obstruction from stones, sludge or casts, haemobilia, and mucoceles have also been described [1, 2, 4-5, 7-9]. Cholecystolithiasis is a very rare late biliary complication following liver transplantation [10]. Commonly, the liver allograft is transplanted without the gallbladder. During the 1980s and early 1990s, few transplant centres preserved the gall-
G. C. Sotiropoulos (Corresponding author), S. Vernadakis, G. M. Kaiser, E. Christodoulou, S. Kykalos, B. Juntermanns, Z. Mathe, F. Weber, A. Paul, J. W. Treckmann Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Germany e-mail: [email protected]
A 59-year-old woman was referred to our department for elective inter
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