A New Technique for Bile Duct Reconstruction in Liver Transplantation.

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Transplant Proc. 2006 Mar;38(2):584-588.

A New Technique for Bile Duct Reconstruction in Liver

Transplantation.

Haberal

M, Boyvat

F, Moray

G, Karakayali

H, Emiroglu

R, Dalgic

A.

Depart General Surgery & Transplantation, Baskent

University Faculty of Medicine, Ankara, Turkey.

Biliary complications are one of the most important problems in liver

transplantation. Despite various refinements of surgical technique, liver

transplantation is associated with significant numbers of biliary problems. In

this article, we describe our novel " intraoperative

transhepatic biliary catheter insertion "

technique for biliary reconstruction in 29 patients, since November 2004

comparing results before and after its implementation. 5-F Kumpe

catheter is inserted into the biliary system in two steps. The first is

completed at the back table, and the second during the recipient operation. The

grafts were from cadavers in 10 cases, with the remaining ones from living

donors. Ten patients received whole-liver grafts, 11 received a right lobe, and

eight received a left-lateral lobe or left lobe. The mean weight of the living

donor grafts was 598 g (range = 270 to 975 g). The mean graft weight-to-body

weight ratio in the living donor liver transplantations was 1.6% +/- 1.0%

(range, 0.8% to 4.1%). Intraoperative transhepatic biliary catheter insertion was performed with

a duct-to-duct anastomosis in 27 cases and with a

Roux-en-Y hepaticojejunostomy in two cases. The only

biliary complication was one case (3.4%) of bile leakage from the anastomotic site. This rate is significantly lower than

that for duct-to-duct biliary reconstructions prior to the new catheter

technique (13.0%; P < .05). This new technique of biliary reconstruction

with intraoperative biliary catheter insertion has

significantly reduced our biliary complication rate. Transhepatic

biliary stenting prevents biliary complications and

makes it simple to maintain percutaneous access in

case such problems arise. However, further studies are needed to compare

incidence rates of biliary complications when our novel technique is used

versus other surgical techniques.

PMID: 16549181 [PubMed - as supplied by publisher]

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