Background. Despite numerous technical improvements, incidence of bile complications after orthotopic liver transplantation (OLT) is not decreasing. End-to-end biliary anastomosis with or without drain is largely performed. However there is no evidence that the anastomotic site on the donor bile duct may infl uence the outcome. Aims. To compare the outcome of end-to-end choledocho-hepaticostomy (CHS) and end-to-end hepatico-hepaticostomy (HHS) for biliary reconstruction after adult cadaveric full size OLT. Methods. From 2006 to 2009, 125 adult liver recipients of a full size liver graft underwent end-to-end biliary reconstruction. If bleeding from the choledochal wall was obvious and cystic junction was high enough, the donor bile duct was cross-sectioned below the cystic junction, and a CHS was performed, drained by a transcystic external drain (C-tube). In the other cases, the donor bile duct was cross-sectioned above the cystic junction and a HHS was performed with insertion of a T-tube in case of major incongruence between graft and recipient ducts. Results. 77 patients (62%) underwent CHS with C-tube, whereas 48 patients underwent HHS (38%), with T-tube inserted in 18 cases. The 2 groups (CHS vs HHS) were comparable regarding age (55+/-9 vs 54+/-9; p=0.5), sex (M= 74% vs M= 67%; p=0.2), BMI (25+/-4 vs 26+/-5; p=0.8) and MELD (16+/-8 vs 18+/-10; p=0.2). Indications for OLT were cancer (51% vs 37%), alcohol (30% vs 46%), viral hepatitis (8% vs 6%) and other (12% vs 10%). The median follow-up was 23 months. There were no difference between groups in overall biliary complication rate (22% vs 21%; p=0.9), biliary leak (4% vs 6%; p=0.5) and stenosis (10% vs 6%; p=0.4). The incidence of choleperitoneum after bile drain removal was similar between patients with C-tube and T-tube (6% vs 4%; p=0.8). Conclusions. Bile duct reconstruction could be safely performed on donor common bile duct, providing that vascularization of the biliary section and anatomy of the cystic junction are adequate. CHS should be preferred to HHS whenever possible because of the larger diameter of the common bile duct and the avaliability of the donor cystic duct which allows easily the insertion of a bile drain.
Anastomotic site on donor bile duct does not influence biliary outcome after adult full size orthotopic liver transplantation
LIDDO, GUIDO;
2010-01-01
Abstract
Background. Despite numerous technical improvements, incidence of bile complications after orthotopic liver transplantation (OLT) is not decreasing. End-to-end biliary anastomosis with or without drain is largely performed. However there is no evidence that the anastomotic site on the donor bile duct may infl uence the outcome. Aims. To compare the outcome of end-to-end choledocho-hepaticostomy (CHS) and end-to-end hepatico-hepaticostomy (HHS) for biliary reconstruction after adult cadaveric full size OLT. Methods. From 2006 to 2009, 125 adult liver recipients of a full size liver graft underwent end-to-end biliary reconstruction. If bleeding from the choledochal wall was obvious and cystic junction was high enough, the donor bile duct was cross-sectioned below the cystic junction, and a CHS was performed, drained by a transcystic external drain (C-tube). In the other cases, the donor bile duct was cross-sectioned above the cystic junction and a HHS was performed with insertion of a T-tube in case of major incongruence between graft and recipient ducts. Results. 77 patients (62%) underwent CHS with C-tube, whereas 48 patients underwent HHS (38%), with T-tube inserted in 18 cases. The 2 groups (CHS vs HHS) were comparable regarding age (55+/-9 vs 54+/-9; p=0.5), sex (M= 74% vs M= 67%; p=0.2), BMI (25+/-4 vs 26+/-5; p=0.8) and MELD (16+/-8 vs 18+/-10; p=0.2). Indications for OLT were cancer (51% vs 37%), alcohol (30% vs 46%), viral hepatitis (8% vs 6%) and other (12% vs 10%). The median follow-up was 23 months. There were no difference between groups in overall biliary complication rate (22% vs 21%; p=0.9), biliary leak (4% vs 6%; p=0.5) and stenosis (10% vs 6%; p=0.4). The incidence of choleperitoneum after bile drain removal was similar between patients with C-tube and T-tube (6% vs 4%; p=0.8). Conclusions. Bile duct reconstruction could be safely performed on donor common bile duct, providing that vascularization of the biliary section and anatomy of the cystic junction are adequate. CHS should be preferred to HHS whenever possible because of the larger diameter of the common bile duct and the avaliability of the donor cystic duct which allows easily the insertion of a bile drain.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
