Duct-to-Duct Biliary Anastomosis in Living Related Liver Transplantation

Azoulay, Daniel; Marín-Hargreaves, Guillermo; Castaing, Denis; RenéAdam, Not Available; Bismuth, H

doi:10.1001/archsurg.136.10.1197

Cited by 56 publications

(47 citation statements)

References 17 publications

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“…Other sources include cut surfaces of liver grafts, cystic duct, drainage tube exit sites, and sinus tracts. 5,31,40,41 Similarly, in our study, all bile leaks manifested in the first 1 to 2 months after transplant, with the majority being anastomotic leaks (30/32; 93.75%) and a minority being leaks from the graft cut surface (2/32; 6.25%). On the other hand, biliary strictures are generally classified into anastomotic and nonanastomotic strictures (ischemic-type biliary lesions), with anastomotic strictures being much more common.…”

Section: Discussionsupporting

confidence: 79%

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Sarhan

Osman²,

Mohamed³

et al. 2017

Exp Clin Transplant

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Objectives: Biliary complications are common after living-donor liver transplant. This retrospective study reviewed our experience with biliary complications in recipients of living-donor liver transplant. Materials and Methods: Over our 9-year study period, 120 patients underwent living-donor liver transplant. Patients were divided into 2 groups, with group A having biliary complications and group B without biliary complications. Both groups were compared, and different treatment modalities for biliary complications were evaluated. Results: Group A included 45 patients (37.5%), whereas group B included 75 patients (62.5%). Biliary complications included bile leak in 17 patients (14.2%), biliary stricture in 11 patients (9.2%), combined biliary stricture with bile leak in 15 patients (12.5%), and sphincter of Oddi dysfunction and cholangitis in 1 patient each (0.8%). Cold ischemia time was significantly longer in group A (P = .002). External biliary drainage was less frequently used in group A (P = .031). Technical success rates of endoscopic biliary drainage and percutaneous transhepatic biliary drainage were 68.3% and 41.7%. Survival rate following relaparotomy for biliary complications was 62.5%. Conclusions: Graft ischemia is an important risk factor for biliary complications. Bile leaks can predispose to anastomotic strictures. The use of external biliary drainage seems to reduce the incidence of biliary complications. Endoscopic and percutaneous transhepatic approaches can successfully treat more than twothirds of biliary complications. Relaparotomy can improve survival outcomes and is usually reserved for patients with intractable biliary complications.

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Section: Discussionsupporting

confidence: 79%

Untitled

Sarhan

Osman²,

Mohamed³

et al. 2017

Exp Clin Transplant

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“…In addition to poor vascularization, extensive tension of the anastomosis is another contraindication of D-D reconstruction. 5,6 A double bile duct orifice on the graft is not an absolute contraindication for D-D anastomosis. Two adjacent bile ducts can be converted to a single orifice using plasty sutures.…”

Section: Discussionmentioning

confidence: 99%

“…5 Although cold ischemia times are relatively short, arterial anastomoses are performed using a microsurgical technique, and skeletonization of bile ducts are avoided, biliary complications are still the most frequent surgical morbidity after LDLT. 6 Biliary reconstruction in LDLT using left-lobe allografts is almost always performed over a Roux limb. However, there is no consensus on biliary reconstruction for right-lobe allografts, and the intent to perform duct-to-duct (D-D) anastomoses, instead of creating a Roux limb, is increasing among liver transplant centers.…”

mentioning

confidence: 99%

Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations

İçöz¹

2003

Liver Transplantation

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“…In the early years of living-donor liver transplantation and split liver transplantation, Roux-en-Y hepaticojejunostomy was the standard biliary reconstructive technique. With growing experience of surgical technique and more emphasis placed on preserving the blood supply around the native common bile duct [31, 32], duct-to-duct anastomosis with or without a biliary drain has been increasingly reported in right lobe living-donor transplants [33,34,35,36,37,38], as well as in right lobe split transplants [39,40,41,42,43,44,45]. Initially, duct-to-duct anastomosis in right lobe living-donor transplants was only performed when a single donor duct was available, whereas more recently, the use of the recipient right and left hepatic ducts, as well as the cystic duct has been reported when multiple anastomoses are needed [46,47,48].…”

Section: Biliary Reconstruction At Liver Transplantationmentioning

confidence: 99%

Biliary Tract Complications after Liver Transplantation: A Review

Wójcicki¹,

Milkiewicz²,

2008

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Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10–30% following whole-organ transplantation and a mortality rate of up to 10%. Biliary leaks and strictures are most common but sphincter of Oddi dysfunction, hemobilia, and biliary obstruction are also observed. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The latter include imperfect anastomosis, T-tube-related complications and the use of partial liver grafts when cut surface biliary leaks or inadvertent bile duct injuries may occur during parenchymal division. The usage of a T-tube for duct-to-duct anastomosis in whole-organ liver transplantation remains controversial, mainly because of the high rates of T-tube-related complications observed in many series. In this article we review the etiology, as well as the main types of biliary complications according to the technique of biliary reconstruction and liver transplant procedure performed. Their management is also discussed with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.

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Duct-to-Duct Biliary Anastomosis in Living Related Liver Transplantation

Cited by 56 publications

References 17 publications

Untitled

Untitled

Biliary reconstructions and complications encountered in 50 consecutive right-lobe living donor liver transplantations

Biliary Tract Complications after Liver Transplantation: A Review

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