title: Meta-analysis of Duct-to-duct versus Roux-en-Y biliary reconstruction following liver transplantation for primary sclerosing cholangitis.
abstract: This meta-analysis aimed to compare outcomes following bile duct reconstruction in patients with primary sclerosing cholangitis (PSC) undergoing liver transplantation depending on whether duct-to-duct or Roux-en-Y anastomosis was utilized. An electronic search was performed of the MEDLINE, EMBASE, PubMed databases using both subject headings (MeSH) and truncated word searches. Pooled risk ratios and mean difference were calculated using the fixed-effects and random-effects models for meta-analysis. Ten studies including 910 patients met the inclusion criteria. There was no difference in the overall incidence of biliary strictures between the two groups [odds ratio (OR) 1.06 (0.68, 1.66); (P = 0.80)]. The anastomotic stricture rate was similar, [OR 1.18 (0.56, 2.50); (P = 0.67)]. Ascending cholangitis was higher in the Roux-en-Y group [OR 2.91 (1.17, 7.23); (P = 0.02)]. Anastomotic bile leak rates, graft survival, PSC recurrence and number of patients diagnosed with cholangiocarcinoma following transplantation were comparable between both groups. Duct-to-duct and Roux-en-Y reconstruction had comparable outcomes. Both techniques are associated with similar incidence of biliary stricture. The bilioenteric reconstruction was associated with a higher risk of cholangitis. The incidence of de novo cholangiocarcinoma was similar in both groups. Duct-to-duct reconstruction should be considered when feasible in patients with PSC.
authors.affiliation: Department of HPB Surgery and Transplant, St James University Hospital, Leeds, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Pandanaboyana
authors.forename: Richard
authors.initials: R
authors.lastname: Bell
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Bartlett
authors.forename: John
authors.initials: J
authors.lastname: McCall
authors.forename: Ernest
authors.initials: E
authors.lastname: Hidalgo
mesh_terms: D000713:Anastomosis, Roux-en-Y; D001649:Bile Duct Diseases / Q000453:epidemiology; D001652:Bile Ducts / Q000601:surgery*; D015209:Cholangitis, Sclerosing / Q000601:surgery*; D003251:Constriction, Pathologic / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation; D011183:Postoperative Complications / Q000453:epidemiology
keywords: Duct to Duct; Roux en Y; liver transplant; primary sclerosing cholangitis