title: Intrahepatic bilioenteric anastomosis after biliary complications of liver transplantation: operative rescue of surgical failures.
abstract: BACKGROUND
  Biliary complications after orthotopic liver transplantation (OLT) are multifactorial in origin. In most series, the frequency of such complications ranges from 5-20%. Most can be treated by endoscopy and/or interventional radiology. For cases in which this option is not successful, surgical approach is indicated. We report the results of reoperation using an intrahepatic bilioenteric anastomosis.
  
  
  METHODS
  The medical charts of patients with biliary complications after OLT during a 10-year period (1997-2007), who failed to respond to nonsurgical treatment and were surgically treated, were reviewed. Roux-en-Y hepatojejunostomy was performed. Segments IV and V were partially removed after cutting the hilar plate, thus obtaining healthy ducts without ischemic or inflammatory reaction and allowing a wide hepatojejunostomy.
  
  
  RESULTS
  Five cases (8.4%) with biliary complications after duct-to-duct anastomosis not amenable to further endoscopic management or interventional radiology were identified. Hepaticojejunostomy was achieved in all cases (wide, tension-free, nonischemic, fine hydrolyzable sutures), and segments IV and V were partially removed. No cholangitis, jaundice, and liver function test abnormalities were present in the postoperative. Mean follow-up was 24 months. Only one patient died of causes not related to bile duct reconstruction during follow-up.
  
  
  CONCLUSIONS
  Intrahepatic hepatojejunostomy with partial resection of segments IV and V offers an excellent therapeutic alternative for biliary complications that require a surgical approach after OLT.
authors.affiliation: Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" (INCMNSZ), Vasco de Quiroga No. 15, Tlalpan 14000, DF, México. mamercado@quetzal.innsz.mx
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Mercado
authors.forename: Mario
authors.initials: M
authors.lastname: Vilatobá
authors.forename: Carlos
authors.initials: C
authors.lastname: Chan
authors.forename: Ismael
authors.initials: I
authors.lastname: Domínguez
authors.forename: Rafael Paulino
authors.initials: RP
authors.lastname: Leal
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Olivera
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008099:Liver / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome