Intraoperative transhepatic biliary catheter insertion technique for biliary reconstruction: early results.

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Intraoperative transhepatic biliary catheter insertion technique for

biliary reconstruction: early results.

Haberal M, Karakayali H, Sevmis S, Boyvat F, Torgay A, Yilmaz U.

Department of General Surgery, Baºkent

University Faculty of Medicine, Ankara, Turkey.

Biliary complications are critical problems in liver

transplantation. Herein, we retrospectively analyzed

the early results of an intraoperative transhepatic biliary catheter insertion technique for

biliary reconstruction. Since November 2004, we have

used this technique in 66 patients (32 children and 34 adults). In the new technique, a 5- F Kumpe

catheter is inserted into the biliary system in 2 steps. One

step is completed at the back table; the second step is completed during the

recipient operation. Fourteen patients received

whole-liver grafts, 25 received a right lobe, and 27 received a left-lateral or

a left lobe. The mean graft weight-to-body weight

ratio in the living-donor liver transplantations was 1.6% +/- 1.0% (range,

0.8%-4.1%). Intraoperative transhepatic biliary catheter insertion was performed with

a duct-to-duct anastomosis in 60 patients and with a

Roux-en-Y hepaticojejunostomy in 6 patients. Five biliary complications occurred in 4 patients. Two of these 4 patients had bile leakage from the anastomotic site during the early postoperative period. Biliary stenoses developed at

the anastomotic site in 2 patients and from a nonanastomotic site in 1 patient in the late postoperative

period. In conclusion, this new technique of biliary

reconstruction with intraoperative biliary catheter

insertion has significantly reduced our complication rate. Transhepatic biliary stenting

seems to prevent biliary complications and makes it simple to maintain percutaneous access in the event that problems arise. Intraoperative transhepatic biliary catheter insertion at the back table

is a safe means of providing good biliary drainage after liver transplantation. PMID: 17524927 [PubMed - indexed

for MEDLINE]

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