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Do biliary endoprostheses decrease biliary complications after liver transplantation?
J S Barkun1, G N Tzimas, M Cantarovich
1Department of General Surgery, Section of Transplantation and Hepatobiliary Surgery, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada. jeffrey.barkun@muhc.mcgill.ca
Aim:
Most technical complications after orthotopic liver transplantation (OLT) are related to the biliary tree. This report reviews the role of routine intraoperative placement of stents to reduce biliary complications.
Methods:
We retrospectively analyzed 396 consecutive OLTs. We reviewed rates of biliary complications after hepaticojejunostomy (HJA) as well as following choledochocholedochostomy (CCA) groups: "experimental" group (routine intraoperative biliary stenting, last 10 months), "recent" control group (nonstented, previous 10 months), "historical" control group (prior to that period of time).
Results:
All groups were matched for donor/recipient characteristics and for graft cold/warm ischemia time. The overall prevalence of biliary complications was 30.7% after CCA versus 35% after HJA. In the experimental group 21 patients had a 4.8% biliary complication rate compared to the recent control and historical groups, where biliary complication rates were 30% and 32.6%, respectively (P <.05).
Conclusions:
The intraoperative use of biliary stents is feasible and appears to decrease the rate of biliary complications. These results support the need for a prospective randomized trial.