Open AccessProspective randomized trial of end‐to‐end versus side‐to‐side biliary reconstruction after orthotopic liver transplantation
Author(s) -
Davidson B. R.,
Rai R.,
Kurzawinski T. R.,
Selves L.,
Farouk M.,
Dooley J. S.,
Burroughs A. K.,
Rolles K.
Publication year - 1999
Publication title -
british journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.202
H-Index - 201
eISSN - 1365-2168
pISSN - 0007-1323
DOI - 10.1046/j.1365-2168.1999.01073.x
Subject(s) - medicine , anastomosis , surgery , liver transplantation , transplantation , side effect (computer science) , randomized controlled trial , orthotopic liver transplantation , computer science , programming language
Background: Biliary reconstruction is the Achilles heel of liver transplantation. Side‐to‐side anastomosis of donor and recipient bile duct has been claimed to be superior to end‐to‐end anastomosis in uncontrolled studies. Methods: A total of 100 consecutive patients undergoing orthotopic liver transplantation were randomized after commencement of the transplant procedure to end‐to‐end or side‐to‐side anastomosis. No T tube drainage was employed. Endoscopic retrograde cholangiography was performed 2 weeks after transplantation and findings were reported by an experienced endoscopist as normal, leak or stricture. Median follow‐up was 53 (range 35–63) months. Results: Patient age, sex, the graft preservation time and indication for transplantation were similar in both groups. Sixty patients received end‐to‐end and 40 side‐to‐side anastomosis. Ten patients randomized to side‐to‐side anastomosis had an end‐to‐end procedure. The total number of biliary complications was similar in both groups (end‐to‐end 32 per cent versus side‐to‐side 30 per cent) as were the number of leaks (17 versus 18 per cent) and biliary strictures (15 versus 12 per cent). There was no difference in the number of biliary complications that required interventional treatment (22 per cent in both groups). Conclusion: Side‐to‐side and end‐to‐end biliary anastomosis at liver transplantation are equally effective. © 1999 British Journal of Surgery Society Ltd