title: Outcomes of side-to-side conversion hepaticojejunostomy for biliary anastomotic stricture after right-liver living donor liver transplantation.
abstract: BACKGROUND
  Conversion hepaticojejunostomy is considered the salvage intervention for biliary anastomotic stricture, a common complication of right-liver living donor liver transplantation with duct-to-duct anastomosis, after failed endoscopic treatment. The aim of this study is to compare the outcomes of side-to-side hepaticojejunostomy with those of end-to-side hepaticojejunostomy.
  
  
  METHODS
  Prospectively collected data of 402 adult patients who had undergone right-liver living donor liver transplantation with duct-to-duct anastomosis were reviewed. Diagnosis of biliary anastomotic stricture was made based on clinical, biochemical, histological and radiological results. Endoscopic treatment was the first-line treatment of biliary anastomotic stricture.
  
  
  RESULTS
  Interventional radiological or endoscopic treatment failed to correct the biliary anastomotic stricture in 13 patients, so they underwent conversion hepaticojejunostomy. Ten of them received end-to-side hepaticojejunostomy and three received side-to-side hepaticojejunostomy. In the end-to-side group, two patients sustained hepatic artery injury requiring repeated microvascular anastomosis, two developed re-stenosis requiring further percutaneous transhepatic biliary drainage and balloon dilatation, and two required revision hepaticojejunostomy. In the side-to-side group, one patient developed re-stenosis requiring further endoscopic retrograde cholangiography and balloon dilatation. No re-operation was needed in this group. Otherwise, outcomes in the two groups were similar in terms of liver function and graft survival.
  
  
  CONCLUSIONS
  Despite the similar outcomes, side-to-side hepaticojejunostomy may be a better option for bile duct reconstruction after failed interventional radiological or endoscopic treatment because it can decrease the chance of hepatic artery injury and allows future endoscopic treatment if re-stricture develops. However, more large-scale studies are warranted to validate the results.
authors: Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.
authors: Kenneth S H
authors: KS
authors: Chok
authors: See Ching
authors: SC
authors: Chan
authors: Tan To
authors: TT
authors: Cheung
authors: Albert C Y
authors: AC
authors: Chan
authors: William W
authors: WW
authors: Sharr
authors: Sheung Tat
authors: ST
authors: Fan
authors: Chung Mau
authors: CM
authors: Lo
mesh_terms: D000328:Adult; D000465:Algorithms; D000714:Anastomosis, Surgical; D001652:Bile Ducts / Q000473:pathology / Q000601:surgery; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002758:Cholangiography; D003251:Constriction, Pathologic / Q000601:surgery; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D007579:Jejunal Diseases / Q000601:surgery*; D007582:Jejunostomy / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies