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Biliary reconstruction in right lobe living-donor liver transplantation: Comparison of different techniques in 321 recipients.

Abstract：

OBJECTIVE:To assess the incidence of biliary complications after right lobe living-donor liver transplantation (LDLT) in patients undergoing duct-to-duct choledochocholedochostomy or Roux-en-Y choledochojejunostomy reconstruction. SUMMARY BACKGROUND DATA:Biliary tract complications remain one of the most serious morbidities following liver transplantation. No large series has yet been carried out to compare the 2 techniques in LDLT. This study undertook a retrospective assessment of the relation between the method of biliary reconstruction used and the complications reported. METHODS:Between February 1998 and June 2004, 321 patients received right lobe LDLT. Biliary reconstruction was achieved with Roux-en-Y choledochojejunostomy in 121 patients, duct-to-duct choledochocholedochostomy in 192 patients, and combined Roux-en-Y and duct-to-duct choledochocholedochostomy in 8 patients. The number of graft bile duct and anastomosis, mode of anastomosis, use of stent tube, and management of biliary complications were analyzed. RESULTS:The overall incidence of biliary complications was 24.0%. Univariate analysis revealed that hepatic artery complications, cytomegalovirus infections, and blood type incompatibility were significant risk factors for biliary complications. The respective incidence of biliary leakage and stricture were 12.4% and 8.3% for Roux-en-Y, and 4.7% and 26.6% for duct-to-duct reconstruction. Duct-to-duct choledochocholedochostomy showed a significantly lower incidence of leakage and a higher incidence of stricture; however, 74.5% of the stricture was managed with endoscopic treatment. CONCLUSIONS:The authors found an increase in the biliary stricture rate in the duct-to-duct choledochocholedochostomy group. Because of greater physiologic bilioenteric continuity, less incidence of leakage, and easy endoscopic access, duct-to-duct reconstruction represents a feasible technique in right lobe LDLT.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Kasahara M,Egawa H,Takada Y,Oike F,Sakamoto S,Kiuchi T,Yazumi S,Shibata T,Tanaka K

doi

10.1097/01.sla.0000206419.65678.2e

subject

Has Abstract

pub_date

2006-04-01 00:00:00

pages

559-66

issue

eissn

0003-4932

issn

1528-1140

pii

00000658-200604000-00020

journal_volume

243

pub_type

杂志文章

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Biliary reconstruction in right lobe living-donor liver transplantation: Comparison of different techniques in 321 recipients.