title: Biliary reconstruction and complications in adult living donor liver transplantation: systematic review and meta-analysis.
abstract: OBJECTIVE
  The purpose of this meta-analysis was to compare outcomes of different techniques used for biliary reconstruction in adult donor liver transplantation.
  
  
  METHODS
  We searched the literature via Pubmed, Embase, Ovid, the Cochrane Hepato-Biliary Group Controlled Trials Regsistry, the Cochrane Central Registry of Controlled Trials, the Cochrane Library database, and Web of Science. Then with the data extracted from the literature, the effects that biliary reconstruction techniques in living-donor liver transplantation (LDLT) had on the occurrence of biliary complications were compared. With the use of random-effects and fixed-effect models, the results were obtained and expressed as odds ratio.
  
  
  RESULTS
  We found 16 eligible studies from various medical centers around the world. Duct-to-duct (DD) reconstruction was performed in the majority of patients (922/1,564). Multiple biliary ducts were encountered in 16.7%-60.4%, and ductoplasty was performed in 7.9%-74% of the patients. Both graft and posterior layer of bile duct anastomosis in DD reconstruction were studied, and no statistically differences in incidence of biliary complications were found between the Roux-en-Y hepaticojejunostomy (RYHJ) and DD groups. Nonsurgical management of biliary complications was the first choice of treatment.
  
  
  CONCLUSIONS
  Our study found that there is no clear evidence in favor of using DD or RYHJ during adult LDLT.
authors: Renji Hospital, Shanghai Jiaotong University School of Medicine, Transplantation Center, Shanghai, China.
authors: S
authors: S
authors: Zhang
authors: Renji Hospital, Shanghai Jiaotong University School of Medicine, Transplantation Center, Shanghai, China.
authors: M
authors: M
authors: Zhang
authors: Renji Hospital, Shanghai Jiaotong University School of Medicine, Transplantation Center, Shanghai, China.
authors: Q
authors: Q
authors: Xia
authors: Renji Hospital, Shanghai Jiaotong University School of Medicine, Transplantation Center, Shanghai, China. Electronic address: zhang_jianjun@21cn.com.
authors: J-J
authors: JJ
authors: Zhang
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods; D000714:Anastomosis, Surgical / Q000379:methods; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures / Q000379:methods; D002768:Choledochostomy; D006801:Humans; D015994:Incidence; D008099:Liver / Q000601:surgery; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008875:Middle Aged