Laparoscopic Treatment of Biliary Peritonitis after Removal of T-Tube in Liver Transplant Patients

Campos, P. Cascales; Romero, Pablo Ramírez; González, R.; Pons, J.A.; Miras, M.; Bueno, F.S; Robles, R; Parrilla, Pascual

doi:10.1016/j.transproceed.2012.05.018

Cited by 5 publications

(5 citation statements)

References 15 publications

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“…MIS techniques have been applied in treating those complications, even in LT recipients that have a previous abdomen surgery. Most of the surgical interventions treat early postoperative complications, occurring in the first months after LT, particularly from day 5 till 8 months post operation [90][91][92]. Usage of robotic assisted surgery has been reported for the successful management of late anastomotic biliary stricture even 2 years after transplantation [88].…”

Section: Discussionmentioning

confidence: 99%

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Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

Avramidou,

Terlemes,

Lymperopoulou

et al. 2024

Livers

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Since the end of the 20th century and the establishment of minimally invasive techniques, they have become the preferred operative method by many surgeons. These techniques were applied to liver surgery for the first time in 1991, while as far as transplantation is concerned their application was limited to the living donor procedure. We performed a review of the literature by searching in Pubmed and Scopus using the following keywords: Liver transplantation, Minimally invasive surgery(MIS) living liver donor surgery. Applications of MIS are recorded in surgeries involving the donor and the recipient. Regarding the recipient surgeries, the reports are limited to 25 patients, including combinations of laparoscopic, robotic and open techniques, while in the living donor surgery, the reports are much more numerous and with larger series of patients. Shorter hospitalization times and less blood loss are recorded, especially in centers with experience in a large number of cases. Regarding the living donor surgery, MIS follows the same principles as a conventional hepatectomy and is already the method of choice in many specialized centers. Regarding the recipient surgery, significant questions arise mainly concerning the safe handling of the liver graft.

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Section: Discussionmentioning

confidence: 99%

“…Interventional radiology procedures can be used for the management of some of these complications with great success [87]. In cases that require surgical intervention, there is the potential for a MIS approach in the treatment of post LT complications [87][88][89][90][91][92].…”

Section: Post Operative Outcome In Lt Using Mis Techniquementioning

confidence: 99%

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

Avramidou,

Terlemes,

Lymperopoulou

et al. 2024

Livers

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“…This approach may require multiple endoscopic retrograde cholangiopancreatographies (ERCP), but has evolved significantly over the last years and has in general good outcomes 31 . Biliary leakage after removal is the main risk of T‐tube usage and although it can also be treated endoscopically by stenting the leak, it often requires percutaneous drainage and at worst PTC placement or redo surgery to treat abscess formation and persistent leaks with a high risk of endangering the patient 32 . Cholangitis is another potentially life‐threatening complication that has been reported in up to 25% in patients with a T‐tube 33 .…”

Section: Discussionmentioning

confidence: 99%

“… 31 Biliary leakage after removal is the main risk of T‐tube usage and although it can also be treated endoscopically by stenting the leak, it often requires percutaneous drainage and at worst PTC placement or redo surgery to treat abscess formation and persistent leaks with a high risk of endangering the patient. 32 Cholangitis is another potentially life‐threatening complication that has been reported in up to 25% in patients with a T‐tube. 33 Due to the potential severe course of these complications, many centers have shifted toward a practice without routine T‐tube placement.…”

Section: Discussionmentioning

confidence: 99%

The role of T‐tubes and abdominal drains on short‐term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations

Kalisvaart

Jonge

Abt

et al. 2022

Clinical Transplantation

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Background: This systematic review and expert panel recommendation aims to answer the question regarding the routine use of T-tubes or abdominal drains to better manage complications and thereby improve outcomes after liver transplantation.Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel to assess the potential risks and benefits of T-tubes and intra-abdominal drainage in liver transplantation (CRD42021243036).Results: Of the 2996 screened records, 33 studies were included in the systematic review, of which 29 (six RCTs) assessed the use of T-tubes and four regarding surgical drains. Although some studies reported less strictures when using a T-tube, there was a trend toward more biliary complications with T-tubes, mainly related to biliary leakage. Due to the small number of studies, there was a paucity of evidence on the effect of abdominal drains with no clear benefit for or against the use of drainage. However, This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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“…The procedure of T-tube removal carries the risk of biliary leakage, with a reported prevalence of 20–30%. The majority of cases is a self-limiting complication which only requires clinical surveillance, but in rare cases, it may worsen to biliary peritonitis, thus requiring invasive treatments [ 29 , 31 ]. Under this perspective, this procedure may be undertaken under ERCP control, with placement of a stent to cover the biliary defect.…”

Section: Discussionmentioning

confidence: 99%

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

et al. 2021

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There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated.

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Laparoscopic Treatment of Biliary Peritonitis after Removal of T-Tube in Liver Transplant Patients

Cited by 5 publications

References 15 publications

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

The role of T‐tubes and abdominal drains on short‐term outcomes in liver transplantation – A systematic review of the literature and expert panel recommendations

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

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