Novel Biliary Reconstruction Techniques During Liver Transplantation.
BACKGROUND
Biliary complications remain a significant problem following liver transplantation. Several surgical options can be used to deal with a significant size mismatch between the donor and recipient bile ducts during the biliary anastomosis. We compared biliary transposition to recipient biliary ductoplasty in cadaveric liver transplant.


METHODS
A total of 33 reconstructions were performed from January 1, 2005 to December 31, 2013. In the biliary transposition group (n=23), 5 reconstructions were performed using an internal stent (5 or 8 French pediatric feeding tube), and 18 were performed without. Of the 10 biliary ductoplasties, 2 were performed with a stent. All patients were managed with standard immunosuppression and ursodiol. Follow-up ranged from 2 months to 5 years.


RESULTS
No patients in the biliary transposition group required reoperation; 1 patient had an internal stent removed for recurrent unexplained leukocytosis, and 2 patients required endoscopic retrograde cholangiography and stent placement for evidence of stricture. Three anastomotic leaks occurred in the biliary ductoplasty group, and 2 patients in the biliary ductoplasty group required reoperation for biliary complications.


CONCLUSIONS
Our results indicate that biliary reconstruction can be performed with either biliary transposition or biliary ductoplasty. These techniques are particularly useful when a significant mismatch in diameter exists between the donor and recipient bile ducts.
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Ian C
IC
Carmody
The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
John
J
Romano
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Humberto
H
Bohorquez
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
Emily
E
Bugeaud
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
David S
DS
Bruce
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Ari J
AJ
Cohen
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
John
J
Seal
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA.
Trevor W
TW
Reichman
Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
George E
GE
Loss
Anastomosis–surgical; bile ducts–extrahepatic; biliary tract surgical procedures; liver transplantation