Biliary Anastomosis After Liver Transplantation Does Not Benefit From T Tube Splintage

Rolles, K; Dawson, K.; Novell, Richard; Hayter, Brenda; Davidson, Brian R; Burroughs, Andrew K.

doi:10.1097/00007890-199402150-00015

Cited by 85 publications

(52 citation statements)

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“…The minority who argued against them noted biliary complications directly related to T-tubes (leak, obstruction, and migration) and the lack of evidence that they enhance healing of biliary anastomoses. 14,15 The debate may finally be swayed by two randomized trials comparing T-tube drainage with no T-tube in liver transplant recipients with D-D anastomoses. 16,17 One trial showed no difference in complication rates, and the other trial showed significantly more complications in the T-tube group.…”

Section: Biliary Reconstructionmentioning

confidence: 99%

Management of biliary problems after liver transplantation

Möser

Wall

2001

Liver Transplantation

110

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Section: Biliary Reconstructionmentioning

confidence: 99%

Management of biliary problems after liver transplantation

Möser

Wall

2001

Liver Transplantation

110

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“…Two previously published studies demonstrated that stricture rate formation was not significantly affected by T-tubes [S, 71. In our recently published study [7], we found that there was no significant difference in biliary leak and stricture formation between the splinted and the nonsplinted group, and that the T-tube itself may be the cause of problems such as biliary tree sepsis, bile sludging or inspissation and biliary leak [7]. Regardless of the kind of biliary anastomosis, it was previously reported that the use of a rubber Ttube instead of tubes of silicon or other materials may be one reason for the low rate of T-tube complications, as it incites enough inflammatory reaction to minimize the risk of leaks from the exit site [4].…”

Section: Discussionmentioning

confidence: 93%

“…monitor the bile output from the transplanted liver, which reflects liver dysfunction in general but is a relatively poor test in terms of specificity: 2. allow radiological access to the biliary tree (however, in a previously published study, the need for ERCP and PTC were decreased in the no T-tube group [5]. It was also established by our previously published study that diagnostic and interventional radiological access to the biliary tree is readily and reliably available via the percutaneous and endoscopic routes; therefore T-tube drainage is hardly justifiable on these grounds alone [7]): 3. prevent late stricture formation.…”

Section: Discussionmentioning

confidence: 98%

“…Stenting the bile duct with a Ttube after OLT is the preferred method of biliary reconstruction to monitor the bile output from the transplanted liver, to allow radiological access to the biliary tree and to prevent late strictures from forming [2,3]. However, there are complications associated with the use of a T-tube: leaks, biliary tree sepsis, frequent radiologic studies and dislodgement of the tube [5,7,81. We have now replaced T-tube splintage with duct-to-duct anastomosis without the use of a T-tube.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Infection rates with and without T-tube splintage of common bile duct anastomosis in liver transplantation

Ben-AriM

Neville²,

Davidson

et al. 1998

Transplant Int

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Stenting the bile duct over a T-tube after orthotopic liver transplantation (OLT) is the preferred method of biliary reconstruction. However, because of complications associated with the use of the T-tube, we evaluated the effect of various biliary anastomoses following 100 consecutive OLT (83 records were available for long-term evaluation) and assessed the clinical outcome of abandoning routine Ttube splintage. Of 16 OLTrecipients with T-tube splintage (one died immediately following OLT and was excluded from the study), 6 patients (40 % ) developed six episodes of septicaemia secondary to biliary and/or intra-abdominal sepsis. Four of these six patients had a biliary leak (27 %). Of 57 patients with duct-to-duct anastomosis without T-tube splintage, 7 patients developed biliary leak (12.3 % ) and only 1 developed septicaemia (1.7 % ) secondary to biliary and intra-abdominal sepsis ( P = 0.0002). Of 11 patients with either a gallbladder conduit or Roux loop, only 1 patient had a biliary leak (9 % ) and there were no septicaemic episodes. In conclusion, direct duct-to-duct anastomosis resulted in significantly less morbidity due to infection without T-tube splintage than the use of a T-tube following OLT, but there were no significant differences in leakage and stricture rates.

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“…Rouch et al 25 found significantly more complications when T tubes were used, attributable largely to the incidence of tuberelated problems. Rolles et al 26 found no benefit from T tubes, although early strictures occurred in 10% of patients with D-D anastomoses who did not have them. The latest report from Randall et al 27 showed no significant difference in the incidence of biliary complications between patients who did and did not have T tubes.…”

Section: Discussionmentioning

confidence: 96%

Biliary reconstruction without T tubes or stents in liver transplantation: Report of 502 consecutive cases

et al. 1997

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Although T tubes and stents are widely used as part of the routine biliary reconstruction in liver transplantation, they have inherent complications and there is no proof that they are beneficial to healing. We do not use T tubes or anastomotic stents, and we reviewed our experience with 502 consecutive, whole-size liver grafts to determine the incidence and nature of biliary complications. Duct-to-duct (D-D) and Roux-en-Y loop-to-duct (RY-D) anastomoses were performed in 321 and 176 cases, respectively. In 62% of cases, the donor gallbladder was transplanted and an external catheter cholecystostomy was fashioned to provide for postoperative cholangiography. In the remaining cases the gallbladder was removed. Biliary complications of all types occurred after 13.5% of the transplants. Anastomotic complications (stricture, obstruction, or leak) occurred in 8.2% of the cases, and they were least frequent (4.0%) with RY-D reconstructions. Gallbladderrelated complications accounted for one quarter of all biliary complications, and they outweighed the advantage of convenient access to the biliary tree for cholangiography. Four patients (0.9%) died of biliary complications. We conclude that routine reconstruction of the biliary tract without T tubes or stents is a safe technique in liver transplantation. Retaining the donor gallbladder as a method of providing cholangiography is not necessary.

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Biliary Anastomosis After Liver Transplantation Does Not Benefit From T Tube Splintage

Cited by 85 publications

References 0 publications

Management of biliary problems after liver transplantation

Management of biliary problems after liver transplantation

Infection rates with and without T-tube splintage of common bile duct anastomosis in liver transplantation

Biliary reconstruction without T tubes or stents in liver transplantation: Report of 502 consecutive cases

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