title: Choledochoduodenostomy is a safe alternative to Roux-en-Y choledochojejunostomy for biliary reconstruction in liver transplantation.
abstract: BACKGROUND
  Bile duct reconstruction during liver transplantation is usually performed by a duct-to-duct anastomosis or a Roux-en-Y choledochojejunostomy (CDJ). Direct anastomosis of the bile duct to the duodenum (choledochoduodenostomy-CDD) is another option for biliary reconstruction. This technique has been used with good outcome for the treatment of choledochal cysts, ampullary stenosis, and major bile duct injuries; however, there is little published experience with CDD in liver transplantation. We provide preliminary evidence that CDD is a safe technique for biliary anastomosis in liver transplant recipients.
  
  
  METHODS
  From September 2000 to August 2007 a total of 619 adult first-time cadaveric or living donor liver transplants were performed at the University of Colorado Health and Science Center. Bile duct repair was performed by direct end-to-end anastomosis in 466 patients and by choledocoenterostomy in the remaining 153 patients, 82 of whom were cadaveric recipients. The cadaveric choledocoenterostomy patients were divided into two groups: CDD in 25 and CDJ in 57 recipients.
  
  
  RESULTS
  There were no significant differences in the 1-year patient or graft survival between the cadaveric groups. The 1-year patient survival was 100% in the CDD group and 97.1% in the CDJ group. The CDD group did not experience more surgical complications compared to the CDJ group.
  
  
  CONCLUSIONS
  Choledochoduodenostomy is a safe alternative to CDJ biliary anastomosis when a duct-to-duct anastomosis cannot be performed. There is no significant difference in mortality, graft survival, or biliary complications. In addition, CDD offers the advantage of postoperative access to the billiary system by endoscopy and avoids complications associated with the CDJ bowel anastomosis.
authors.affiliation: Division of Transplant Surgery, University of Colorado Health Sciences Center, Campus Box C-318, 7th Floor 1675 Aurora Court, Aurora, CO 80045, USA.
authors.forename: William
authors.initials: W
authors.lastname: Bennet
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zimmerman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Campsen
authors.forename: Mercedes Susan
authors.initials: MS
authors.lastname: Mandell
authors.forename: Tom
authors.initials: T
authors.lastname: Bak
authors.forename: Michael
authors.initials: M
authors.lastname: Wachs
authors.forename: Igal
authors.initials: I
authors.lastname: Kam
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002768:Choledochostomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome