[Biliary reconstruction in liver transplantation: is a biliary tutor necessary?]
José Luis Fernández-Aguilar1, Julio Santoyo, Miguel Angel Suárez Muñoz
1Unidad de Cirugía Hepatobiliopancreática y Trasplante Hepático, Hospital Universitario Carlos Haya, Málaga, España. jlfaguilar@telefónica.net
Objectives:
To assess the incidence and type of biliary complications in liver transplantation after biliary reconstruction with or without a biliary tutor.
Material And Method:
A prospective, non-randomized study of 128 consecutive patients undergoing elective liver transplantation was performed. Retransplantations, emergency transplantations, hepaticojejunostomy and patients who died within 3 months of causes other than biliary complications were excluded. Group I (n = 64) underwent termino-terminal choledochocholedochostomy with a Kehr tube and group II (n = 64) underwent choledochocholedochostomy without Kehr tube. Complications, therapeutic procedures, reoperations and survival free of biliary complications were analyzed.
Results:
The overall rate of biliary complications was 15% (17% in group I and 14% in group II). Types of complication (overall and in groups I and II, respectively) consisted of fistulas 4% (6% vs. 3%), stenosis 8% (4% vs. 12%), and Kehr dysfunction 3%. The mean number of therapeutic procedures, including endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, trans-Kehr cholangiography and drainage of collections, was 2.1 vs. 2 per complicated patient. The overall reoperation rate was 5% (2% vs. 9%) (p < 0.05). One-year survival free of biliary complications was 85% vs. 82% (Log Rank = 0.5).
Conclusions:
No statistically significant differences were found in complications after choledocho-choledocho anastomosis with or without a biliary tutor. However, the patient group that did not receive a biliary tutor required more complex procedures for treatment of complications, as well as a greater number of reoperations.