Systematic review and meta-analysis of biliary reconstruction techniques in orthotopic deceased donor liver
Fabio Colagrossi Paes-Barbosa1, P C Massarollo, W M Bernardo
1Liver and Portal Hypertension Group, Irmandade da Santa Casa de Misericórdia de São Paulo, Medical Sciences School, São Paulo, Brazil. fabiocpb@hotmail.com
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 side-to-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.