Spatulated end-to-end bile duct reconstruction in orthotopic liver transplantation

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Clinical Transplantation

Volume 21 Issue 1 Page 7 - January/February 2007

Spatulated end-to-end bile duct reconstruction in orthotopic liver transplantation

Corresponding author: AK Buczkowski, MD, Department of Surgery, Section of Hepatobiliary, Pancreatic and Transplant Surgery, 910 West 10th Ave., 3rd Floor Vancouver, BC, Canada V5Z 4E3.Tel.: +1-; fax: +1-;e-mail: andrzei.buczkowski@...

Buczkowski AK, Schaeffer DF, Kim PTW, Ho SGF, Yoshida EM, Steinbrecher UP, Erb SR, Chung SW, Scudamore CH. Spatulated end-to-end bile duct reconstruction in orthotopic liver transplantation.Clin Transplant 2007: 21: 7–12. © Blackwell Munksgaard, 2006

Abstract

Abstract: Biliary complications continue to be a major source of morbidity following orthotopic liver transplantation. The aim of this study was to analyze the incidence and management of biliary complications related to the technique of bile duct reconstruction.

The patients were stratified into two groups: group I (n = 39) had bile duct reconstruction performed by an end-to-end single interrupted suture choledochocholedochostomy (EE-CDCD) and group II (n = 38) had a spatulated end-to-end CDCD (spEE-CDCD) reconstruction; both groups had an intraductal stent. The groups were similar in age, gender, liver transplant indications and Pugh score. Ten biliary complications (26%), including five bile leaks (13%) and five biliary strictures (13%), were observed in the EE-CDCD group, while one biliary stricture (2.6%) occurred in the spEE-CDCD group (p < 0.05). Subsequent imaging studies and endoscopic retrograde cholangiopancreatography were performed less often in patients undergoing spEE-CDCD reconstruction (p < 0.05). The technique of a spatulated end-to-end bile duct reconstruction provides a significant improvement in lowering biliary complication rates in liver transplant patients. Despite the modest number of cases in this study this technique shows promise and has become the technique of choice in our institution.