ERCP-Related Perforations

Biliary and Vascular Complications after Liver Transplantation–From Diagnosis to Treatment

“…There are currently no definite recommendations regarding the optimal type of biliary reconstruction [ 34 ]. The choledocho-choledochian anastomosis is generally preferred because of the lower technical difficulty, preservation of the sphincter of Oddi and easier subsequent endoscopic access to the biliary system [ 35 , 36 ]. Preservation of the sphincter of Oddi also decreases the risk of developing ascending cholangitis [ 35 , 36 ].…”

“…The choledocho-choledochian anastomosis is generally preferred because of the lower technical difficulty, preservation of the sphincter of Oddi and easier subsequent endoscopic access to the biliary system [ 35 , 36 ]. Preservation of the sphincter of Oddi also decreases the risk of developing ascending cholangitis [ 35 , 36 ]. The placement of a Kehr tube at the level of the choledoco-choledochian anastomosis enables the measurement of bile flow in the early postoperative period but also maintains an easy access path for the radiological evaluation of the biliary system [ 36 , 37 , 38 ].…”

“…Preservation of the sphincter of Oddi also decreases the risk of developing ascending cholangitis [ 35 , 36 ]. The placement of a Kehr tube at the level of the choledoco-choledochian anastomosis enables the measurement of bile flow in the early postoperative period but also maintains an easy access path for the radiological evaluation of the biliary system [ 36 , 37 , 38 ]. However, Kehr tubes have been linked with the risk of biliary fistulas and potential episodes of cholangitis at the time of their removal [ 36 , 37 , 38 ].…”

“…The placement of a Kehr tube at the level of the choledoco-choledochian anastomosis enables the measurement of bile flow in the early postoperative period but also maintains an easy access path for the radiological evaluation of the biliary system [ 36 , 37 , 38 ]. However, Kehr tubes have been linked with the risk of biliary fistulas and potential episodes of cholangitis at the time of their removal [ 36 , 37 , 38 ]. The rate of overall complications was higher among patients in whom this tube was fitted (33% in patients with a Kehr tube vs. 15% in patients without a Kehr tube), and the survival rate was slightly lower [ 35 ].…”

“…Thus, choledocho-choledochian anastomosis without Kehr tube insertion is the most frequently used surgical technique in liver transplantation. This may be associated with the subsequent development of biliary strictures in approximately 20% of cases [ 36 , 37 , 38 ].…”