title: The use of stents for duct-to-duct anastomoses of biliary reconstruction in orthotopic liver transplantation.
abstract: OBJECTIVE
  Biliary anastomotic complications remain a major cause of morbidity in liver transplant recipients. The objective of this retrospective study is to reassess the use of anastomotic stents for biliary reconstruction while focusing on an end-to-end choledochocholedochostomy (EECC) in orthotopic liver transplantation (OLT).
  
  
  METHODS
  EECC for the biliary reconstruction in OLT was performed in 115 patients. Sixty-three had their bile duct reconstructed over a T-tube stent (S group) while the remaining 52 patients underwent the same procedure without the stent (non-S group). The two groups were compared in terms of biliary complications and the conversion rate to a hepaticojejunostomy (HJS).
  
  
  RESULTS
  Twenty-three biliary complications were observed in the OLT patients. In the S group, the incidence of a biliary leak was 12.7%, 8 of 63 patients in which 5 patients showed a bile leak when T tubes were removed. The rate of biliary stricture in the S group was 25.4%, or 16 patients. This stricture rate was not significantly different from the 13.5% rate observed in the non-S group (p=0.086). In the non-S group, 7 patients showed a biliary stricture. Four of 7 patients also developed a bile leak identified to be an anastomotic leak, which consequently resulted in HJS. A total of 6 patients, 5.2% of all OLT patients, underwent a subsequent revision of their primary anastomoses. The incidence of conversion from EECC to HJS in the non-S group, 57.1% was significantly higher than that in the S group, 12.5% (p=0.046).
  
  
  CONCLUSIONS
  EECC (i.e. with or without a T-tube stent) is both a safe and effective technique for biliary reconstruction in OLT. However, the conversion rate from EECC to HJS in the non-S group was significantly higher than that in the S group. An indwelling T-tube stent is therefore considered to be useful for both achieving the lowest possible rate of severe anastomotic stricture and to prevent any subsequent intervention.
authors.affiliation: Department of Surgery, Hamamatsu Medical Center, Hamamatsu, Japan. t-kusano@hmedc.or.jp
authors.forename: Toshiomi
authors.initials: T
authors.lastname: Kusano
authors.forename: Henry B
authors.initials: HB
authors.lastname: Randall
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Ascher
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D001652:Bile Ducts / Q000601:surgery*; D001658:Biliary Fistula / Q000209:etiology / Q000601:surgery; D002768:Choledochostomy / Q000379:methods*; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery