Spatulated end-to-end bile duct reconstruction in orthotopic liver transplantation.

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Clin Transplant. 2007 Jan-Feb;21(1):7-12.

Spatulated

end-to-end bile duct reconstruction in orthotopic

liver transplantation.

Buczkowski AK, Schaeffer DF, Kim PT, Ho SG, Yoshida EM, Steinbrecher UP, Erb SR, Chung SW, Scudamore CH.

Department of Surgery, The University

of British Columbia and The British

Columbia Transplant Society, Vancouver,

BC, Canada.

Buczkowski AK, Schaeffer DF, Kim PTW, Ho SGF, Yoshida

EM, Steinbrecher UP, Erb

SR, Chung SW, Scudamore CH. Spatulated

end-to-end bile duct reconstruction in orthotopic

liver transplantation. Clin

Transplant 2007: 21: 7-12. © Blackwell Munksgaard, 2006Abstract: Biliary complications continue to

be a major source of morbidity following orthotopic

liver transplantation. The aim of this study was to

analyze the incidence and management of biliary complications related to the

technique of bile duct reconstruction. The patients

were stratified into two groups: group I (n = 39) had bile duct reconstruction

performed by an end-to-end single interrupted suture choledochocholedochostomy

(EE-CDCD) and group II (n = 38) had a spatulated

end-to-end CDCD (spEE-CDCD) reconstruction; both

groups had an intraductal stent. The

groups were similar in age, gender, liver transplant indications and Pugh score. Ten biliary complications (26%), including five bile leaks

(13%) and five biliary strictures (13%), were observed in the EE-CDCD group,

while one biliary stricture (2.6%) occurred in the spEE-CDCD

group (p < 0.05). Subsequent imaging studies and endoscopic retrograde cholangiopancreatography

were performed less often in patients undergoing spEE-CDCD

reconstruction (p < 0.05). The technique of a spatulated end-to-end bile duct reconstruction provides a

significant improvement in lowering biliary complication rates in liver

transplant patients. Despite the modest number of

cases in this study this technique shows promise and has become the technique

of choice in our institution. PMID: 17302585 [PubMed - in process]

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