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21 May 2009

Reduction of biliary complication rate using continuous suture and no biliary drainage for duct-to-duct anastomosis in whole-organ liver transplantation

R Klęk, M Post, K Jarosz, J Butkiewicz, J Lubikowski, S Zeair, M Wójcicki

Ann Transplant 2009; 14(1): 29-29 :: ID: 880303

Abstract

Background: Biliary complications (BCs) following liver transplantation (LTx) are related to various factors including surgical technique and the use of biliary drains for duct-to-duct (DD) anastomosis. We report the influence of changing the surgical technique on BCs in our centre.
Material/Methods: The incidence, treatment and outcome of BCs following adult LTx (between February 2002 and February 2007) with DD anastomosis were analyzed. There were 101 LTx with DD anastomosis in 99 patients, of  which 84 were analyzed. Recipients, who died within 30 days of LTx without  evidence of BCs and one patient with biliary strictures secondary to hepatic artery
thrombosis, were excluded. Until late-2004, DD anastomosis with  interrupted sutures over an external biliary drain (DD/BD) was performed in 35 patients. Following this, no biliary drain was used for DD anastomosis (DD/non-BD) created routinely with a continuous suture in 49 patients.
Results: DD anastomosis with interrupted sutures over a biliary drain was  associated with a higher incidence of both total (31% vs. 8%; P=0.008) and late (>30 days) BCs (20% vs. 2%; P=0.008). All biliary leaks in patients with  DD/BD reconstruction occurred from the exit site of the drain following its  removal. No statistically significant differences were found when incidence of biliary strictures and the necessity of surgical intervention were compared.  One patient died due to a biliary complication.
Conclusions: DD anastomosis performed with a continuous suture technique and no external biliary drainage reduces the incidence of BCs after LTx.

Keywords: Liver Transplantation

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358