title: Nonsurgical policy for treatment of bilioenteric anastomotic stricture after living donor liver transplantation.
abstract: Biliary complications remain a significant cause of morbidity following living donor liver transplantation. The purpose of this retrospective study was to assess the outcome of nonsurgical management for hepatojejunostomy stricture in our institution. We reviewed 22 patients with hepatojejunostomy stricture among the 231 patients who underwent living donor liver transplantation between June 1990 and December 2005. Hepatojejunostomy stricture was confirmed by percutaneous transhepatic or endoscopic retrograde cholangiography. Anastomotic strictures were treated by balloon dilatation. Percutaneous transhepatic cholangiography was performed on 15 of the 22 patients. Two of 15 patients, with complete obstruction of the anastomosis, were treated successfully by Yamanouchi magnet compression anastomosis. Although another two patients died of infectious disease that was unlikely to have been related to biliary complications, anastomotic patency was maintained in the other 13 patients. Endoscopic retrograde cholangiography was performed on seven of the 22 patients. None of the 22 patients required re-operation or died of biliary complications. The 5-year graft survival rate of 85.6% in the 22 patients with stricture was equivalent to that of the patients without stricture (82.9%, P = 0.98). Advances in intervention techniques have enabled wider application of nonsurgical approaches for this complication, and fair results have been obtained.
authors: Division of Transplantation, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. mita@hsp.md.shinshu-u.ac.jp
authors: Atsuyoshi
authors: A
authors: Mita
authors: Yasuhiko
authors: Y
authors: Hashikura
authors: Yuichi
authors: Y
authors: Masuda
authors: Yasunari
authors: Y
authors: Ohno
authors: Koichi
authors: K
authors: Urata
authors: Yuichi
authors: Y
authors: Nakazawa
authors: Toshihiko
authors: T
authors: Ikegami
authors: Masaru
authors: M
authors: Terada
authors: Hironori
authors: H
authors: Yamamoto
authors: Shin-Ichi
authors: S
authors: Miyagawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000601:surgery; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies