Biliary reconstruction without T-tube in liver transplantation.
Biliary complications have been reported in 9% to 34% of liver transplant patients. Although most centers seem to prefer a duct-to-duct anastomosis without a T-tube when feasible, the best method of biliary reconstruction remains controversial. The aim of this study was to review our experience on reconstruction of the biliary tract without drainage. Forty-one patients underwent 45 liver transplants over two periods. Forty patients underwent 15 liver transplants from October 1992 to March 1995; and 27 underwent 30 liver transplants from January 2002 to February 2003. Our standard biliary reconstruction was an end-to-end anastomosis without drain. The overall actuarial survival was 72.7% at 1 year, 64.7% at 3 years, and 56.6% at 5 years. The mean follow-up was 23 months. Eight patients (22.2%) developed biliary tract complications: five patients papillary dysfunction (13.9%); two, biliary stricture (5.5%); and one, biliary sludge without evidence of stricture (2.8%). Papillary dysfunction represented 62.5% of all complications. Biliary reconstruction without drainage may be routinely performed since the complications are only those not related to the T-tube.
Bacchella
T
T
Transplante e Cirurgia do Fígade, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil. bacchell@usp.br
Figueira
E R R
ER
Makdissi
F F
FF
Rocha-Santos
V
V
Martino
R B
RB
Andraus
W
W
Canedo
L F
LF
Machado
M A C
MA
Machado
M C C
MC
D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000601:surgery*; D002768:Choledochostomy; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors