Long-term follow-up study of biliary reconstructions and complications after adult living donor liver transplantation: feasibility of duct-to-duct reconstruction with a T-tube stent.
The aim of this study was to analyze the feasibility of duct-to-duct biliary reconstruction (hepaticohepaticostomy) with a T-tube stent (HH-T) after adult living donor liver transplantation (LDLT) based on long-term follow-up. We retrospectively evaluated 63 primary adult LDLTs who had survived >1 month from March 1999 to January 2008. We compared the incidence of bile leaks and biliary strictures (BS) in 3 groups of patients: Roux-en-Y hepaticojejunostomy (HJ; n = 18); duct-to-duct hepaticohepaticostomy with external stents except a T-tube (HH; n = 26); and HH-T (n = 19). Median follow-up was longer among the HJ (63 months) than the other groups (32 months in HH and 25 months in HH-T; P = .04). Bile leaks developed in 8 of the HJ cases (44%); 9 of the HH cases (33%); and 1 of the HH-T cases (5%; P = .02). All cases with bile leaks (n = 18) were treated using continuous drainage, 15 of them (83%) successfully. BS developed in 4 HJ cases (22%); 12 HH cases (46%), and 4 HH-T cases (21%; P = .12). Intervention for BS (n = 20) was successful in 10 cases (50%) via an endoscopic approach and 6 cases (30%) via a percutaneous transhepatic approach. Operative management for BS was required in 4 cases (20%). Biliary reconstruction using HH-T may be effective to prevent bile leaks after LDLT. However, HH-T may not decrease the incidence of BS after adult LDLT.
Kobayashi
T
T
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. kobataka@med.niigata-u.ac.jp
Sato
Y
Y
Yamamoto
S
S
Oya
H
H
Hara
Y
Y
Watanabe
T
T
Kokai
H
H
Hatakeyama
K
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D005705:Gallbladder Diseases / Q000601:surgery; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015607:Stents; D055815:Young Adult