title: Roux-en-Y choledochojejunostomy versus duct-to-duct biliary anastomosis in liver transplantation for primary sclerosing cholangitis: a meta-analysis.
abstract: BACKGROUND
  Roux-en-Y choledochojejunostomy and duct-to-duct anastomosis are potential methods for biliary reconstruction in liver transplantation (LT) for recipients with primary sclerosing cholangitis (PSC). However, there is controversy over which method yields superior outcomes. The purpose of this study was to evaluate the outcomes of duct-to-duct versus Roux-en-Y biliary anastomosis in patients undergoing LT for PSC.
  
  
  METHODS
  Studies comparing Roux-en-Y versus duct-to-duct anastomosis during LT for PSC were identified based on systematic searches of 9 electronic databases and multiple sources of gray literature.
  
  
  RESULTS
  The search identified 496 citations, including 7 retrospective series, and 692 patients met eligibility criteria. The use of duct-to-duct anastomosis was not associated with a significant difference in clinical outcomes, including 1-year recipient survival rates (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.65-1.60; P = .95), 1-year graft survival rates (OR, 1.11; 95% CI, 0.72-1.71; P = .64), risk of biliary leaks (OR, 1.23; 95% CI, 0.59-2.59; P = .33), risk of biliary strictures (OR, 1.99; 95% CI, 0.98-4.06; P = .06), or rate of recurrence of PSC (OR, 0.94; 95% CI, 0.19-4.78; P = .94).
  
  
  CONCLUSIONS
  There were no significant differences in 1-year recipient survival, 1-year graft survival, risk of biliary complications, and PSC recurrence between Roux-en-Y and duct-to-duct biliary anastomosis in LT for PSC.
authors: Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
authors: M M
authors: MM
authors: Wells
authors: K P
authors: KP
authors: Croome
authors: E
authors: E
authors: Boyce
authors: N
authors: N
authors: Chandok
mesh_terms: D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000401:mortality; D001652:Bile Ducts / Q000601:surgery*; D016009:Chi-Square Distribution; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002768:Choledochostomy / Q000009:adverse effects / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome