Duct-to-duct biliary reconstruction following liver transplantation for primary sclerosing cholangitis.
The biliary complications in patients undergoing biliary reconstruction by duct-to-duct (D-D) anastomosis or with a Roux-en-Y loop (RL) at the time of liver transplantation for primary sclerosing cholangitis (PSC, 16 D-D, 10RL) or primary biliary cirrhosis (PBC, 31 D-D, 1 RL) were reviewed and compared. Patients were followed up for a mean period of 32 months. Extrahepatic biliary strictures occurred in 18.7%, 10% and 9.7% of DD-PSC, RL-PSC and DD-PBC patients, respectively, leaks in 6.2%, 20% and 6.4% DD-PSC, RL-PSC and DD-PBC patients, respectively (P = NS). Four intrahepatic biliary abnormalities developed in the PSC group. Duct-to-duct anastomosis did not significantly increase the risk of stricture formation or bile leaks in PSC patients compared to PBC patients. We conclude that duct-to-duct biliary reconstruction following liver transplantation for PSC is satisfactory unless the distal common bile duct is strictured.
Distante
V
V
University Department of Surgery, School of Medicine, Royal Free Hospital, Hampstead, London, UK.
Farouk
M
M
Kurzawinski
T R
TR
Ahmed
S W
SW
Burroughs
A K
AK
Davidson
B R
BR
Rolles
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D001660:Biliary Tract Diseases / Q000209:etiology / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies