[Bile duct reconstruction in liver transplantation]

Area of Science:

• Hepatobiliary surgery
• Transplantation surgery
• Surgical complications

Context:

• Biliary anastomosis complications are frequent after liver transplantation, occurring in approximately ten percent of cases.
• The primary cause is the unfavorable blood supply to the biliary tract.
• Despite improved surgical techniques, managing biliary complications remains a challenge.

Purpose:

• To review common biliary reconstruction techniques following liver transplantation.
• To discuss the management of biliary tract complications encountered in clinical practice.
• To present the authors' experience with fourteen liver transplantations and subsequent biliary complications.

Summary:

• Several biliary reconstruction methods exist, including end-to-end choledochocholedochostomy (preferred), side-to-side choledochocholedochostomy for differing duct diameters, gallbladder-conduit for length discrepancies, and choledochojejunostomy with Roux-en-Y loop for absent or destroyed recipient ducts.
• The authors experienced three complications in fourteen liver transplantations: anastomosis leakage and stenosis after choledochocholedochostomy, successfully converted to hepaticojejunostomy. Intrahepatic biliary stenosis was treated with percutaneous transhepatic dilatation.

Impact:

• Understanding these techniques and complication management strategies is crucial for improving outcomes in liver transplantation.
• This review highlights the importance of selecting appropriate biliary reconstruction methods based on individual patient anatomy.
• Effective management of biliary complications can reduce patient morbidity and improve graft survival rates.