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Orthotopic liver transplantation (OLT) has many roles in biliary disease. OLT provides excellent results for patients with unresectable hilar cholangiocarcinoma. OLT prolongs survival in primary biliary cirrhosis not responsive to therapy and improves quality of life. OLT remains the durable option for patients with primary sclerosing cholangitis and complications of end-stage liver disease or recurrent cholangitis secondary to biliary obstruction. Indications for OLT after bile duct injury are chronic liver disease secondary to biliary cirrhosis and acute liver failure from associated vascular injury. OLT is treatment of choice for Caroli disease and syndrome when fibrosis leads to portal hypertension and esophageal varices., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Because it offers several advantages over open cholecystectomy, laparoscopic cholecystectomy has largely replaced open cholecystectomy for the management of symptomatic gallstone disease. The only potential disadvantage is a higher incidence of major bile duct injury. Although prevention of these biliary injuries is ideal, when they do occur, early identification and appropriate treatment are critical to improving the outcomes of patients suffering a major bile duct injury. This report delineates the key factors in classification (and its relationship to mechanism and management), identification (intraoperative and postoperative), and management principles of these bile duct injuries., (Published by Elsevier Inc.)

Laparoscopic hepatobiliary surgery has advanced rapidly in the past few years. Laparoscopic cholecystectomy has been the most significant advance and its value will become even greater as the incidence of biliary injuries is decreased. LCBDE and staging laparoscopy are very promising procedures. Other hepatobiliary laparoscopic operations such as liver resections and biliary-enteric anastomoses are still in developmental stages and will require a longer period of assessment.

Although rare in even the busiest trauma centers, lacerations, transections, or avulsions of the extrahepatic biliary ducts occur in patients who have experienced both blunt and penetrating abdominal trauma. The diagnosis is difficult in the patient undergoing observation only after blunt abdominal trauma and may not be made for several weeks. Ductal injuries have also been missed at operation in patients with associated injuries to the hilum of the liver or pancreatoduodenal complex. Scanning with HIDA, endoscopic retrograde cholangiography, and intraoperative cholangiography has been useful in detecting occult ductal injuries. The technique of repair in stable patients depends primarily on the location and extent of the ductal injury and has ranged from lateral choledochorrhaphy with absorbable sutures to biliary enteric bypass. T tubes or stents are frequently used because of the small size of the ductal system, although no agreement exists on how long they should remain in place after operation. Results of biliary enteric bypass operations for complex injuries are excellent as long as the tenuous blood supply of the bile duct is preserved and the anastomosis is tension free.

What can be said with certainty regarding endotherapy for biliary injuries associated with laparoscopic or conventional cholecystectomy? On the one hand, ongoing cystic duct and most bile duct leaks close rapidly after sphincterotomy or placement of a stent or both. Such therapy does not preclude the need for drainage of sizable bilomas. On the other hand, acute and ultimate success of endotherapy appears to be contingent on the degree and perhaps the cause of injury. Although ERCP is useful in diagnosing transection or an inadvertently stapled right hepatic duct, treatment of these conditions remains in the surgical realm. Nor is it likely, in my opinion, that a duct that has been stapled across 75% of its diameter or one with an extremely long stenosis, suggesting devascularization and ischemic injury, will respond to either a radiologic or endoscopic approach. In this setting, ERCP may be used diagnostically, or therapy may be undertaken in an attempt to convert an urgent surgical intervention into an elective and controlled one. Endotherapy appears to be useful, however, for a considerable subset of patients with inadvertent thermal or incisional injury, although need for periodic dilation therapy and exchange of the stent remain limiting factors. Moreover, even in patients with apparent short-term or intermediate-term success, caution is urged to continue periodic clinical and liver function test surveillance because recurrent stenosis may occasionally be subtle and present not as jaundice or cholangitis but as secondary biliary cirrhosis with its attendant consequences.

The development of repair of biliary tract operative injuries proceeded in tandem with the advancement of abdominal surgery in the late nineteenth and early twentieth centuries. The important auxiliary role of stents, imaging, and hilar dissection, and the recognition of the common duct arterial supply are related to technical advances. The place of percutaneous or endoscopic dilation is being established in the 1990s.

Major biliary complications of laparoscopic cholecystectomy may be prevented by an understanding of extrahepatic biliary ductal and arterial anatomic relationships. The common patterns of anatomic variations important to the surgeon performing laparoscopic cholecystectomy are reviewed with respect to recently reported biliary injury during this procedure. Recommendations for delineating biliary anatomy and avoiding laparoscopic complications are reviewed.

Radionuclide techniques are currently used to fully evaluate many congenital and acquired abnormalities of the gastrointestinal tract of children. Frequently, the anatomic and functional data provided by the nuclear examination are definitive. In the study of many disease entities, tracer techniques have replaced more cumbersome or invasive procedures. Although the radiopharmaceuticals and instrumentation are similar as applied to both children and adults, the uniqueness of children and their disease entities requires special consideration when performing and interpreting their studies. In this review, the principle radionuclide examinations used in the evaluation of pediatric gastrointestinal disorders are detailed and examples are illustrated.

Trauma kills and maims more children each year than infections and neoplasms combined, and 10 per cent of trauma-related deaths are due to abdominal injury. This article examines the various modalities used in evaluating abdominal trauma, and discusses the imaging findings of injury of the organs of the abdomen.

Radionuclide techniques serve an important role in evaluating childhood injuries. Frequently, they can be employed as the initial and definitive examination. At times they represent the only modality that will detect specific injuries such as the skeletal system. Familiarity with the advantages and limitations of tracer techniques will insure appropriate management of childhood injuries.