Duct-to-duct reconstruction in liver transplantation for primary sclerosing cholangitis is associated with fewer biliary complications in comparison with hepaticojejunostomy

Abstract

There is no consensus on the preferred type of biliary reconstruction for patients undergoing orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC). The aim of this study was to compare long-term outcomes after OLT for PSC using either duct-to-duct anastomosis or Roux-en-Y hepaticojejunostomy for biliary reconstruction. In a consecutive series of 98 adult patients undergoing OLT for PSC, 45 underwent duct-to-duct reconstruction, and 53 underwent Roux-en-Y biliary reconstruction. The median follow-up was 8.2 years (interquartile range 5 3.9-14.5 years). The outcomes of the 2 groups were compared. There were no significant differences in patient demographics or general surgical variables between the groups. The overall patient and graft survival rates were similar for the 2 groups. The incidence of biliary strictures and biliary leakage within the first year after transplantation did not differ between the 2 groups. However, significantly more patients in the Roux-en-Y group suffered at least 1 episode of cholangitis within the first year (9% in the duct-to-duct group versus 25% in the Roux-en-Y group, P 5 0.04). In addition, Roux-en-Y reconstruction was associated with a significantly higher rate of late-onset (>1 year after transplantation) nonanastomotic biliary strictures (NAS) in comparison with duct-toduct reconstruction (24% versus 7% at 5 years and 30% versus 7% at 10 years, P 5 0.01). In conclusion, duct-to-duct biliary reconstruction in patients with PSC is associated with lower rates of posttransplant cholangitis and late-onset NAS in comparison with Roux-en-Y hepaticojejunostomy. If technically and anatomically feasible, duct-to-duct anastomosis can be performed safely in patients undergoing OLT for PSC.

Impact of non‐anastomotic biliary strictures after liver transplantation on healthcare consumption, use of ionizing radiation and infectious events

“…In the present study, 70% of the patients with NAS experienced at least one BC and 49% were classified as recurrent (3 ≥ episodes), which was significantly more than liver recipients in the control group. The significant higher rate of BC episodes in the NAS group persisted after exclusion of patients with a Roux‐en‐Y biliary anastomosis, which has been shown to be a separate risk factor for BC . Our results are comparable to numbers found in previous studies and show that patients with NAS are subject to an increased risk for BC after liver transplantation.…”

Meta-analysis of Duct-to-duct versus Roux-en-Y biliary reconstruction following liver transplantation for primary sclerosing cholangitis

“…More recent publications have continued to question the need for systematically performing a RY anastomosis, with series of DD anastomosis in patients with PSC showing similar results. Some studies favour a DD reconstruction , while others show comparable results . In this meta‐analysis, pooled data from 10 studies including 910 patients did not show any difference with respect to biliary complications, other than cholangitis, or graft survival when both techniques were compared.…”

Laparoscopic total colectomy for ulcerative colitis after liver transplantation is feasible

“…The main goal is to prevent biliary stricture although a recent study showed that a duct-to-duct reconstruction could bring excellent results. [5] During the described procedure, we found the intestinal loop very easily and we cut the transverse meso-colon in front of the jejunal loop way.…”