Biliary tract complications of side-to-side without T tube versus end- to-end with or without tt tube choledochocholedochostomy in liver transplant recipients

John M. Rabkin, Susan L. Orloff, Matt H. Reed, Leslie J. Wheeler, Christopher L. Corless, Kent G. Benner, Ken D. Flora, Hugo R. Rosen, Ali J. Olyaei

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75 Scopus citations

Abstract

Background. Biliary anastomotic complications remain a major cause of morbidity in liver transplant recipients, ranging between 10% and 50% in large clinical series. An end-to-end choledochocholedochostomy with or without T tube (CDCD EE with T tube and CDCD EE w/o T tube) and a Roux-en Y choledochojejunostomy have been standard methods for biliary drainage. Methods. The objectives of this retrospective study were to: (1) evaluate the incidence of biliary tract complications using a new method of side-to-side choledochocholedochostomy without T tube (CDCD SS w/o T tube) and (2) compare the results of CDCD SS w/o T tube with those of CDCD EE with T tube and CDCD EE w/o T tube. From September 1991 through June 1996, 279 orthotopic liver transplants were performed in 268 patients and followed through December 1996 (minimum of 6 month's follow-up). A total of 227 CDCD anastomoses in 220 patients were studied (7 retransplants >30 days): CDCD EE with T tube (n= 124), CDCD EE w/o T tube (n=44), and CDCD SS w/o T tube (n=59). Results. Sixty-nine biliary complications were observed in 220 patients (30%). Anastomotic and/or T-tube leaks were seen in 43 patients (19%), and anastomotic strictures were found in 26 patients (12%). Forty patients (18%) required percutaneous or endoscopic stent placement (6%) or surgical interventions (12%). CDCD EE with T tube had the highest incidence of biliary leak requiring rehospitalization but the lowest anastomotic stricture and intervention rate and the lowest 6-month mortality rate. Conclusions. CDCD EE with T tube was superior to CDCD EE or CDCD SS w/o T tube despite the increased number of rehospitalizations. CDCD SS w/o T tube did not offer significant advantages over conventional biliary anastomotic techniques.

Original languageEnglish (US)
Pages (from-to)193-199
Number of pages7
JournalTransplantation
Volume65
Issue number2
DOIs
StatePublished - Jan 27 1998

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ASJC Scopus subject areas

  • Transplantation

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