title: Continuous versus interrupted suture for end-to-end biliary anastomosis during liver transplantation gives equal results.
abstract: Biliary complications following orthotopic liver transplantation have been reported in 10% to 30% of patients. Most surgeons perform an end-to-end choledochocholedochostomy with interrupted sutures for biliary reconstruction. The goal of this study was to compare biliary complications between interrupted suture (IS) and continuous suture (CS) techniques during liver transplantation in which an end-to-end choledochocholedochostomy over an internal biliary stent was performed. A retrospective cohort study of 100 consecutive liver transplants occurring between December 2003 and July 2005 was conducted. An end-to-end choledochocholedochostomy over an internal biliary stent was performed during liver transplantation. Data were analyzed using Kaplan-Meier methods, t tests, and chi-square tests of proportions. IS and CS techniques were used in 59 and 41 patients, respectively, for biliary reconstruction during liver transplantation. Mean follow-up time for the CS group was 17 +/- 8 months and 15 +/- 7 months for the IS group (P = .21). The overall biliary complication rate was 15%. There was no difference in the proportion of leaks (CS = 7.3%, IS = 8.5%; P = .83) or strictures (CS = 9.8%, IS = 5.1%; P = .37) between groups. Kaplan-Meier event rates show no difference in leaks (P = .79), strictures (P = .41), graft survival (P = .52), and patient survival (P = .32) by anastomosis type. In conclusion, there was no difference in biliary complications, graft survival, or patient survival between the 2 groups. CS and IS techniques for biliary reconstruction during liver transplantation yield comparable outcomes.
authors.affiliation: Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, TN 37232-4753, USA.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Castaldo
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Wright
authors.forename: D Lee
authors.initials: DL
authors.lastname: Gorden
authors.forename: Beau S
authors.initials: BS
authors.lastname: Kelly
authors.forename: Ravi S
authors.initials: RS
authors.lastname: Chari
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003135:Common Bile Duct / Q000601:surgery*; D003137:Common Bile Duct Diseases / Q000175:diagnosis*; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D013536:Suture Techniques; D016896:Treatment Outcome