Biliary tract reconstruction in liver transplantation
Wall, W.J.; Grant, D.R.; Mimeault, R.E.; Girvan, D.P.; Duff, J.H.
Canadian Journal of Surgery. Journal Canadien de Chirurgie 32(2): 97-100
1989
ISSN/ISBN: 0008-428X PMID: 2493330 Document Number: 329251
Refinements in biliary tract reconstruction and the frequent use of cholangiography have produced a marked decline in the number of deaths from biliary complications after liver transplantation. The authors' method of reconstruction differs from those of others in that it employs no stents or T tubes and retains the donor gallbladder, allowing access to the biliary tract for radiologic purposes in the post-transplant period. In a series of 161 consecutive liver transplants, the frequency of biliary complications was 13.6% (15 anastomotic and 7 gallbladder-related). Of three deaths that occurred in patients with biliary complications, one was due to the complication itself. A Roux-en-Y reconstruction with anastomosis to the donor duct was associated with the lowest anastomotic complication rate (2.2%). Upper abdominal surgery before transplantation, especially shunting, was a major risk factor for biliary complications.