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Biliary complications in adult‐to‐adult living donor right lobe liver transplants
Author(s) -
Cotterell A.,
Fisher R.,
Maluf D.,
Stravitz R.,
Sterling R.,
Luketic V.,
Sanyal A.,
Shiffman M.,
Posner M.
Publication year - 2006
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2006.00577_3_3.x
Subject(s) - medicine , anastomosis , liver transplantation , surgery , bile duct , roux en y anastomosis , biliary tract , duct (anatomy) , left hepatic duct , transplantation , weight loss , gastric bypass , obesity
Biliary complications are a major cause of morbidity after living donor right lobe liver transplantation. The purpose of this study was to compare the incidence of biliary complications after Roux‐en‐Y vs. duct‐to‐duct reconstruction in adult‐to‐adult right lobe liver transplantation. Patients and methods: This study reports on 75 patients who underwent 77 right lobe liver transplants. During the initial experience beginning in June 1998, a Roux limb was used routinely for biliary reconstruction. Since September 2000 a duct‐to‐duct biliary anastomosis was performed if technically feasible. Results: Of 49 procedures involving Roux‐en‐Y reconstruction, 15 patients (30.6%) experienced 18 biliary complications, including 7 cases of biliary anastomotic strictures, 3 cut surface leaks requiring intervention, 1 anastomotic leak, 1 anastomotic obstruction, and 1 excluded segmental duct. In addition, 5 patients experienced episodes of cholangitis unrelated to strictures. Of the 47 patients with Roux‐en‐Y reconstruction, 32 are alive a mean of 75 months posttransplant. Of 28 patients with duct‐to‐duct reconstruction, 8 (28.6%) experienced 9 biliary complications including 5 anastomotic strictures (3 of which required operative intervention), 2 anastomotic leaks, 1 cut surface leak requiring intervention, and 1 excluded segmental duct. Twenty‐four of 28 patients with duct‐to‐duct reconstruction are alive a mean of 39 months posttransplant. Conclusion: The incidence of biliary complications after right lobe living donor liver transplantation is about 30% regardless of the method used for biliary reconstruction. A duct‐to‐duct biliary anastomosis is an acceptable alternative to Roux‐en‐Y reconstruction if technically feasible.