title: An Improved Suture Technique for Perform Biliary Reconstruction in Orthotopic Liver Transplantation.
abstract: BACKGROUND
  The biliary anastomosis remains to be the Achilles' heel of liver transplantation. The incidence of biliary complications (e.g., stenosis and leakage) is immanent and the optimal type of reconstruction is unclear. The aim of this study was to compare 2 different bile duct suture techniques regarding their benefits in the prevention of biliary complications.
  
  
  METHODS
  From 1992 to 2012, the transplanted patients (n=394) of our center were analyzed retrospectively in terms of suture techniques and consecutive biliary complications. Secondary, possible risk factors (cold ischemic time, donor age, and preoperative liver function) were examined. An end-to-end choledocho-choledochostomy without T-tube was performed during orthotopic liver transplantation whenever possible. In group 1 (n=123) the biliary reconstruction was performed completely by continuous-suture technique. In group 2 (n=164) continuous-suture technique was also performed in posterior wall of the bile duct, but the anterior wall was closed by interrupted-suture technique.
  
  
  RESULTS
  The overall biliary complication rate was 19.6%. There were no significant differences in biliary complications between the groups. Analysis of risk factors showed no influence on the complication rate.
  
  
  CONCLUSIONS
  The argument for the interrupted-suture technique is a better overview and a lower risk to grab the posterior wall during the anastomotic realization. The threads of the anterior wall can be presented individually and then be knotted.
authors.affiliation: Department of Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Azin
authors.initials: A
authors.lastname: Jafari
authors.affiliation: Department of Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Burkhard
authors.initials: B
authors.lastname: Stoffels
authors.affiliation: Department of Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Jörg C
authors.initials: JC
authors.lastname: Kalff
authors.affiliation: Department of Surgery, University Hospital Bonn, Bonn, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Manekeller
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D001649:Bile Duct Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001652:Bile Ducts / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D014184:Transplantation, Homologous; D016896:Treatment Outcome