Biliary tract reconstruction in liver transplantation.
Refinements in biliary tract reconstruction and the frequent use of cholangiography have produced a marked decline in the number of deaths from biliary complications after liver transplantation. The authors' method of reconstruction differs from those of others in that it employs no stents or T tubes and retains the donor gallbladder, allowing access to the biliary tract for radiologic purposes in the post-transplant period. In a series of 161 consecutive liver transplants, the frequency of biliary complications was 13.6% (15 anastomotic and 7 gallbladder-related). Of three deaths that occurred in patients with biliary complications, one was due to the complication itself. A Roux-en-Y reconstruction with anastomosis to the donor duct was associated with the lowest anastomotic complication rate (2.2%). Upper abdominal surgery before transplantation, especially shunting, was a major risk factor for biliary complications.
Wall
W J
WJ
Department of Surgery, University Hospital, London, Ont.
Grant
D R
DR
Mimeault
R E
RE
Girvan
D P
DP
Duff
J H
JH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001662:Biliary Tract Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged