Results of Biliary Reconstructions in LTX at Our Center

[Guest guest]

Results of Biliary Reconstructions in

Liver Transplantation at Our Center

M. Haberal,

H. Karakayali, S. Sevmis,

R. Emiroglu, G. Moray and G. Arslan

aBaskent University,

Faculty of Medicine, Ankara, Turkey

Abstract

Biliary

complications are some of the most critical problems in liver transplantation. Despite various refinements in surgical technique,

different types of liver transplantations are associated with significant

numbers of biliary problems. In this study, we

analyzed the results of biliary reconstructions in 127 liver transplant

recipients at our center from April 2001 to May 2006. Through

November 2004, we used different techniques for biliary reconstruction in 66 of

these patients, including duct-to-duct (DD) anastomoses,

Roux-en-Y hepaticojejunostomy (RYHJ), anastomoses over T tubes or stents, and anastomoses

without stenting. During the

first period, we used a DD anastomosis in 15 cadaveric whole liver grafts and in 25 right lobe and 12

left lobe or left lateral segment grafts from living-related donors. RYHJ was preferred in 2 cadaveric

and 12 left lateral segment grafts. Beginning in

November 2004, we employed intraoperative transhepatic biliary catheter insertion in 61 patients (29

children, 32 adults). In the most recent 61 cases of

13 liver grafts from cadavers and 48 from living-related donors, 14 patients (2

children and 12 adults) received whole-liver grafts, 22 (all adults) a right

lobe, and 26 (all children) a left lateral or left lobe. Intraoperative transhepatic

biliary catheter insertion was performed with DD anastomosis

in 55 cases and with RYHJ in 6 cases. The mean

complication rate decreased from 24% to 8.1% during the period using a new

biliary reconstruction technique. Five biliary

complications occurred in four patients. The new

technique of biliary reconstruction using intraoperative

biliary catheter insertion has significantly reduced the biliary complication

rate. Transhepatic biliary stenting prevents biliary complications and maintains percutaneous access when problems arise. Intraoperative transhepatic biliary catheter insertion at

the back table is a safe way to provide good biliary drainage after liver

transplantation.