Prospective randomized trial of end-to-end versus side-to-side biliary reconstruction after orthotopic liver transplantation

Davidson, Brian R; Rai, Rakesh; Kurzawinski, Tomasz R.; Selves, L.; Farouk, Marwan; Dooley, James; Burroughs, Andrew K.; Rolles, K

doi:10.1046/j.1365-2168.1999.01073.x

Cited by 92 publications

(56 citation statements)

References 22 publications

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“…In addition, a good perfusion of the bile duct is warranted, since the 3 and 9 o'clock vessels are completely preserved by incision of the bile duct at 12 and 6 o'clock ( Figure 2). However, a randomized trial comparing these technical modifications showed no significant differences (35). Overall, no differences between running and interrupted sutures have been detected (19,36), but there is some indication for less AS with interrupted sutures (5.1% vs. 9.8%) (36).…”

Section: Prophylaxis Of Anastomotic Complicationsmentioning

confidence: 92%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

251

233

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Due to a vulnerable blood supply of the bile ducts, biliary complications are a major source of morbidity after liver transplantation (LT). Manifestation is either seen at the anastomotic region or at multiple locations of the donor biliary system, termed as nonanastomotic biliary strictures. Major risk factors include old donor age, marginal grafts and prolonged ischemia time. Moreover, partial LT or living donor liver transplantation (LDLT) and donation after cardiac death (DCD) bear a markedly higher risk of biliary complications. Especially accumulation of several risk factors is critical and should be avoided. Prophylaxis is still a major issue; however no gold standard is established so far, since many risk factors cannot be influenced directly. The diagnostic workup is mostly started with noninvasive imaging studies namely MRI and MRCP, but direct cholangiography still remains the gold standard. Especially nonanastomotic strictures require a multidisciplinary treatment approach. The primary management of anastomotic strictures is mainly interventional. However, surgical revision is finally indicated in a significant number of cases. Using adequate treatment algorithms, a very high success rate can be achieved in anastomotic complications, but in nonanastomotic strictures a relevant number of graft failures are still inevitable.

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Section: Prophylaxis Of Anastomotic Complicationsmentioning

confidence: 92%

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Seehofer

Eurich

Veltzke‐Schlieker

et al. 2013

American Journal of Transplantation

251

233

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“…With improvements in organ selection, retrieval, preservation, and implantation techniques such complications have been reduced dramatically. Biliary complications, however, still occur in 10–30% following whole-organ OLT resulting in mortality rates up to 10% of cases [5,6,7,8,9,10,11] (table 1). …”

Section: Introductionmentioning

confidence: 99%

Biliary Tract Complications after Liver Transplantation: A Review

Wójcicki¹,

Milkiewicz²,

2008

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Biliary complications continue to be a major cause of morbidity in liver transplant recipients with an incidence of 10–30% following whole-organ transplantation and a mortality rate of up to 10%. Biliary leaks and strictures are most common but sphincter of Oddi dysfunction, hemobilia, and biliary obstruction are also observed. Biliary complications may be related to various factors such as hepatic artery patency, preservation injury, cytomegalovirus infection, chronic ductopenic rejection, ABO incompatibility, and technical reasons. The latter include imperfect anastomosis, T-tube-related complications and the use of partial liver grafts when cut surface biliary leaks or inadvertent bile duct injuries may occur during parenchymal division. The usage of a T-tube for duct-to-duct anastomosis in whole-organ liver transplantation remains controversial, mainly because of the high rates of T-tube-related complications observed in many series. In this article we review the etiology, as well as the main types of biliary complications according to the technique of biliary reconstruction and liver transplant procedure performed. Their management is also discussed with interventional radiology and endoscopic techniques emerging as the preferred treatment option, obviating the need for surgery in a selected majority of patients.

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“…The end-to-end or side-to-side choledochocholedochostomy (CCS) reconstruction program for OLT has been accepted by most transplant centers (Davidson et al, 1999;Castaldo et al, 2007). The T-tube is widely used in CCS as a stent of the biliary tract, for it can not only protect against anastomotic strictures, but also help to monitor the flow and color of bile, and makes it easy to perform cholangiography when necessary (Lerut et al, 1987;Shaked, 1997;de Simone et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation: a meta-analysis

Huang

Jiang

2011

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To compare biliary complications after biliary tract reconstruction with or without T-tube in orthotopic liver transplantation. Methods: Randomized control trials (RCTs) and comparative studies were identified by a computerized literature search of the Cochrane Library, MEDLINE (1966/1-2010/4), Scopus (1980/1-2010/4), ClinicalTrials.gov (2010/4), the Cochrane Hepato-Biliary Group Controlled Trials Register, and the Cochrane Central Register of Controlled Trials. Studies and data were extracted and assessed independently. Dichotomous outcomes were reported as odds ratios (ORs) and weighted mean difference with 95% confidence intervals (CI). Results: Five RCTs and eight comparative studies with a total of 1 608 subjects were identified. The data showed that the operation with T-tube had better outcomes for duct stenosis (P=0.01, OR=0.45, 95% CI 0.24-0.85). The operations with or without T-tube had equivalent outcomes as follows: overall biliary complications (P=0.85, OR=1.15, 95% CI 0.28-4.72), bile leaks (P=0.38, OR=0.75, 95% CI 0.39-1.42), and cholangitis (P=0.24, OR=4.64, 95% CI 0.36-60.62). These results were strengthened by the analysis of all thirteen non-randomized and randomized studies. Conclusions: Our systematic review and meta-analysis suggest that the insertion of a T-tube reduces the incidence of biliary stenosis without increasing the incidence of other biliary complications.

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Prospective randomized trial of end-to-end versus side-to-side biliary reconstruction after orthotopic liver transplantation

Abstract: Side-to-side and end-to-end biliary anastomosis at liver transplantation are equally effective.

Cited by 92 publications

References 22 publications

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Complications After Liver Transplantation: Old Problems and New Challenges

Biliary Tract Complications after Liver Transplantation: A Review

Value of T-tube in biliary tract reconstruction during orthotopic liver transplantation: a meta-analysis

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