title: Transcystic cholangiogram access via rubber band with early withdrawal after liver transplantation: a safe technique.
abstract: OBJECTIVE
  Since different techniques have been described for cholangiogram access after liver transplantation, we compared two different methods for patients with duct-to-duct biliary anastomoses.
  
  
  METHODS
  Adult liver transplant patients from program inception in 1993 to May 2003 in whom a duct-to-duct biliary anastomosis with a T-tube choledochostomy were compared with those having a transcystic duct catheter using a rubber band. We excluded 10 patients in which a different technique was used or graft or patient survived less than 21 days. Group A (n = 28,) had a number 10 T-tube exteriorized through the recipient main bile duct; and group B (n = 33) a number 5 Bard ureteral stent tied to the cystic stump with reabsorbable suture and secured with a hemorrhoidal rubber ligature.
  
  
  RESULTS
  The biliary complication rate was lower among the transcystic catheter group (9.1%, 3/33) compared to the T-tube group (35.7%, 10/28). Postcatheter withdrawal peritonitis was present in two patients in the T-tube group, one of whom required emergency laparotomy. A satisfactory postoperative cholangiogram was obtained in both groups. The transcystic catheter was withdrawn on average at 29 days, compared to 136 days in the T-tube group.
  
  
  CONCLUSIONS
  Both techniques are equally effective in obtaining a satisfactory postoperative cholangiogram. However, the transcystic catheter technique allows a significantly earlier withdrawal with fewer complications compared to the T-tube technique.
authors.affiliation: Department of Surgery, Transplant Unit, Clinica Alemana Santiago, Santiago, Chile. finnocenti@alemana.cl
authors.forename: F
authors.initials: F
authors.lastname: Innocenti
authors.forename: J
authors.initials: J
authors.lastname: Hepp
authors.forename: R
authors.initials: R
authors.lastname: Humeres
authors.forename: H
authors.initials: H
authors.lastname: Rios
authors.forename: L
authors.initials: L
authors.lastname: Suárez
authors.forename: R
authors.initials: R
authors.lastname: Zapata
authors.forename: E
authors.initials: E
authors.lastname: Sanhueza
authors.forename: M
authors.initials: M
authors.lastname: Rius
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002404:Catheterization / Q000379:methods; D002758:Cholangiography / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000502:physiology; D016343:Monitoring, Intraoperative; D012449:Safety