Reduction of Biliary Complication Rate Using Continuous Suture and No Biliary Drainage for Duct-to-Duct Anastomosis in Whole-Organ Liver Transplantation

Wójcicki, Maciej; Lubikowski, Jerzy; Klek, R.; Post, Mariola; Jarosz, Konrad; Białek, Andrzej; Wunch, M.; Czuprynska, M.

doi:10.1016/j.transproceed.2009.07.091

Cited by 13 publications

(12 citation statements)

References 33 publications

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“…The article analysis identified three randomized clinical trials [11, 13, 14], six clinical trials [5, ], and 48 historical cohort studies (Table 2) [1, ].…”

Section: Resultsmentioning

confidence: 99%

“…In spite of great technological advances in liver transplantation, biliary complications remain a major cause of morbidity and mortality [1]. The most frequent of these complications are fistulas and stenoses, although others such as Oddi sphincter dysfunction, hemobilia, biliary obstruction by mucocele of the cystic duct, calculus, and biliary sludge have also been reported [2].…”

Section: Introductionmentioning

confidence: 99%

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Systematic review and meta‐analysis of biliary reconstruction techniques in orthotopic deceased donor liver transplantation

Paes-Barbosa

Massarollo

Bernardo

et al. 2010

J Hepato Biliary Pancreat

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Background Biliary complications remain a major cause of morbidity and mortality in liver transplantation and the biliary anastomosis technique could increase this risk. The aim of this study was to compare the effects of biliary reconstruction techniques in orthotopic liver transplantation on the incidence of biliary complications. Methods A systematic review and meta-analysis using the Medline-PubMed, EMBASE, Scielo-LILACS, and Cochrane Databases were performed comparing biliary reconstruction techniques in liver transplantation with regard to the occurrence of biliary complications. Number needed to treat (NNT) was calculated at a 95% confidence interval.Results Fifty-seven articles were selected (3 randomized clinical trials, 6 clinical trials, and 48 historical cohort studies). There was a lower risk for biliary complications (NNT = 6) using end-to-end choledochocholedochostomy (EECC) without drainage compared with EECC with drainage. The biliary complication risk was lower (NNT = 4) for sideto-side choledochocholedochostomy (SSCC) with drainage compared with SSCC without drainage. No difference was found between EECC without drainage and SSCC with drainage. Conclusions According to our results, considering the highest level of evidence available in the literature, we suggest that biliary reconstruction in liver transplantation should be performed using EECC or SSCC, without drainage in the former, and with drainage in the latter.

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“…The article analysis identified three randomized clinical trials [11, 13, 14], six clinical trials [5, ], and 48 historical cohort studies (Table 2) [1, ].…”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systematic review and meta‐analysis of biliary reconstruction techniques in orthotopic deceased donor liver transplantation

Paes-Barbosa

Massarollo

Bernardo

et al. 2010

J Hepato Biliary Pancreat

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“…We believe that these entities are interlinked and a large number of cases may be required to determine the statistical significance. An indwelling T-tube is a matter of debate, as discussed above [17,18,21,22,28,39,47,52,54] Other operative factors, including ischaemia-reperfusion injury with prolonged warm/cold ischaemic time and difference in the preservation methods/solutions had been reported as risk factors [44,53,61,69], but according to recent reports, those factors seem to be more associated with ischaemic-type, nonanastomotic strictures than with anastomotic complications, which is preferred to be dealt as a distinct entity [116][117][118][119][120][121][122][123]. At the same time, eliminating these factors might contribute to reduce anastomotic strictures [124].…”

Section: Risk Factorsmentioning

confidence: 99%

Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome

Akamatsu¹,

Sugawara²,

Hashimoto³

2010

Transplant International

284

285

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Summary Biliary reconstruction remains common in postoperative complications after liver transplantation. A systematic search was conducted on the PubMed database and 61 studies of retrospective or prospective institutional data were eligible for this review. The study comprised a total of 14 359 liver transplantations. The overall incidence of biliary stricture was 13%; 12% among deceased donor liver transplantation (DDLT) patients and 19% among living donor liver transplantation (LDLT) recipients. The overall incidence of biliary leakage was 8.2%, 7.8% among DDLT patients and 9.5% among LDLT recipients. An endoscopic strategy is the first choice for biliary complications; 83% of patients with biliary stricture were treated by endoscopic modalities with a success rate of 57% and 38% of patients with leakage were indicated for endoscopic biliary drainage. T‐tube placement was not performed in 82% of duct‐to‐duct reconstruction. The incidence of biliary stricture was 10% with a T‐tube and 13% without a T‐tube and the incidence of leakage was 5% with a T‐tube and 6% without a T‐tube. A preceding bile leak and LDLT procedure are accepted risk factors for anastomotic stricture. Biliary complications remain common, which requires further investigation and the refinement of reconstruction techniques and management strategies.

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“…3 An end-to-end bile duct anastomosis is the technique of choice in most institutions for adult patients with healthy bile ducts of suitable length and calibre. 3 An end-to-end bile duct anastomosis is the technique of choice in most institutions for adult patients with healthy bile ducts of suitable length and calibre.…”

Section: Discussionmentioning

confidence: 99%

To stent or not to stent: the use of transanastomotic biliary stents in liver transplantation and patient outcomes

Ong

Slater

Hodgkinson

et al. 2018

ANZ Journal of Surgery

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Reduction of Biliary Complication Rate Using Continuous Suture and No Biliary Drainage for Duct-to-Duct Anastomosis in Whole-Organ Liver Transplantation

Cited by 13 publications

References 33 publications

Systematic review and meta‐analysis of biliary reconstruction techniques in orthotopic deceased donor liver transplantation

Systematic review and meta‐analysis of biliary reconstruction techniques in orthotopic deceased donor liver transplantation

Biliary reconstruction, its complications and management of biliary complications after adult liver transplantation: a systematic review of the incidence, risk factors and outcome

To stent or not to stent: the use of transanastomotic biliary stents in liver transplantation and patient outcomes

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