Biliary complications in relation to the technique of biliary reconstruction in adult liver transplant recipients.
Biliary complications are known as a weak point of liver transplantation. Their occurrence can be related to the practice of draining the biliary anastomosis performed at the time of transplantation. At our institution, routine of anastomotic biliary drainage was abandoned in June 2004.


OBJECTIVE
We sought to assess the occurrence and character of biliary complications following orthotopic liver transplantation in relation to the technique of anastomosis.


METHODS
In two groups of transplantees: last 100 transplantations with biliary drainage (48 females and 52 males aged 17 to 64 years) and last 100 transplantations without drainage (52 females and 48 males aged 18 to 67 years). The results of treatment were compared, for biliary complications and their influence on further management. In both groups, the main indications for transplantation were various types of cirrhosis as well as cholestatic diseases. In most cases (167) we performed a cholangiojejunal Roux-en-Y (CBD) end-to-end anastomosis, less commonly (33 cases) hepaticojejunal anastomoses.


RESULTS
In the first group, biliary complications (bile leak at the site of drainage, bile leak after T-tube removal, CBD strictures) requiring surgical or endoscopic intervention, occurred in 17% recipients. In one case, the biliary complication resulted in retransplantation. In the second group, biliary complications occurred in 11% patients. None of them caused organ loss.


CONCLUSIONS
Abandoning drainage of the biliary anastomosis has reduced the occurrence of early biliary complications after orthotopic liver transplantation.
Alsharabi
A
A
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland. Alsharabi@o2.pl
Zieniewicz
K
K
Michałowicz
B
B
Patkowski
W
W
Nyckowski
P
P
Wróblewski
T
T
Grzelak
I
I
Paluszkiewicz
R
R
Hevelke
P
P
Remiszewski
P
P
Cieślak
B
B
Kornasiewicz
O
O
Kotulski
M
M
Skwarek
A
A
Urban
M
M
Sańko-Resmer
J
J
Krawczyk
M
M
D000328:Adult; D000368:Aged; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001662:Biliary Tract Surgical Procedures; D002648:Child; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D006801:Humans; D008100:Liver Abscess / Q000473:pathology / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D018810:Magnetic Resonance Angiography; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies