title: Roux-en-Y bleeding after living donor liver transplantation: a novel technique for surgical treatment.
abstract: Upper gastrointestinal bleeding (GIB) is one of the most common gastroenterologic complications following liver transplantation. The aim of this study is to define the prevalence of GIB due to Roux- en Y (R-Y) enteral anastomoses after living donor liver transplantation (LDLT) and recommend an anastomotic technique for easy surgical intervention. Ninety-five patients underwent 96 LDLT from June 1999 through January 2003. R-Y biliary reconstruction was employed in 43 patients. Anastomoses were end-to-side (ES) in the first 25 patients and side-to-side (SS) type in the last 18 patients. GIB occurred in 13 patients (30%). The R-Y anastomotic line was shown to be the bleeding site in 10 patients. Anastomoses were in ES fashion in 7 of 10 patients (70%). In other words 28% of ES and 17% of SS anastomoses displayed a bleeding episode after LDLT. Four patients required surgical intervention (Three ES, one SS), namely an operative rate of 9%. The type of the jejunojejunostomy, the UNOS or Child-Pugh scores, the presence of preexisting portal hypertension, the duration of portal vein clamping, the GRWR of patients, revealed no statistical significant difference between bleeding and non- bleeding patients. Although statistical analyses did not reveal any significant difference (P =.47), GIB was higher among patients with an ES type of anastomoses. As a result we recommend a jejunojejunostomy in SS fashion on the antimesenteric borders of the jejunal segments with a 3-4 cm blind intestinal segment. The surgical procedure for R-Y bleeding may then be performed without disrupting the jejunojejunostomy.
authors.affiliation: Ege University Medical School, Department of Organ Transplantation and Research Center, Izmir, Turkey. gicoz@me.ege.edu.tr
authors.forename: G
authors.initials: G
authors.lastname: Icoz
authors.forename: M
authors.initials: M
authors.lastname: Kilic
authors.forename: M
authors.initials: M
authors.lastname: Zeytunlu
authors.forename: O
authors.initials: O
authors.lastname: Yaprak
authors.forename: C
authors.initials: C
authors.lastname: Arikan
authors.forename: Y
authors.initials: Y
authors.lastname: Yuzer
authors.forename: Y
authors.initials: Y
authors.lastname: Tokat
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects* / Q000379:methods*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D015995:Prevalence; D015996:Survival Rate; D013997:Time Factors