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Biliary reconstruction for liver transplantation and management of biliary complications: Overview and survey of current practices in the United States
Author(s) -
Vallera Raymond A.,
Cotton Peter B.,
Clavien PierreAlain
Publication year - 1995
Publication title -
liver transplantation and surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1074-3022
DOI - 10.1002/lt.500010302
Subject(s) - liver transplantation , medicine , current (fluid) , general surgery , transplantation , intensive care medicine , gastroenterology , engineering , electrical engineering
iver transplantation has become a standard L medical treatment as a result of many advances in surgical technique, organ preservation, and immunosuppression. Despite this progress, problems of the bile duct remain a significant cause of short-term and long-term morbidity. Biliary complications can extend the hospital stay significantly, and they often require invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC), re-operation, or even retransplantation. In this article, we discuss the two major biliary reconstructions, choledocho-choledochostomy (CC) and Roux-en-Y choledocho-jejunostomy (RYCJ), with their respective advantages and shortcomings. In addition, options for management of biliary complications are addressed. Because of the lack of consensus in the preferred types of biliary reconstruction and management of common complications, we have conducted a survey of 65 of the largest adult liver transplant centers in the United States to supplement this overview. Centers were identified based on participation in the United Network of Organ Sharing (UNOS) Liver Transplant Registry. Data were collected from April 19, 1994 to May 25, 1994. Fortynine of sixty-five (75%) directors of liver transplantation responded to the survey representing over 90% of all adult orthotopic liver transplants (OLT) performed yearly in the United States.