An Improved Suture Technique for Perform Biliary Reconstruction in Orthotopic Liver Transplantation
Azin Jafari1, Burkhard Stoffels1, Jörg C Kalff1
1Department of Surgery, University Hospital Bonn, Bonn, Germany.
Background:
The biliary anastomosis remains to be the Achilles' heel of liver transplantation. The incidence of biliary complications (e.g., stenosis and leakage) is immanent and the optimal type of reconstruction is unclear. The aim of this study was to compare 2 different bile duct suture techniques regarding their benefits in the prevention of biliary complications.
Material And Methods:
From 1992 to 2012, the transplanted patients (n=394) of our center were analyzed retrospectively in terms of suture techniques and consecutive biliary complications. Secondary, possible risk factors (cold ischemic time, donor age, and preoperative liver function) were examined. An end-to-end choledocho-choledochostomy without T-tube was performed during orthotopic liver transplantation whenever possible. In group 1 (n=123) the biliary reconstruction was performed completely by continuous-suture technique. In group 2 (n=164) continuous-suture technique was also performed in posterior wall of the bile duct, but the anterior wall was closed by interrupted-suture technique.
Results:
The overall biliary complication rate was 19.6%. There were no significant differences in biliary complications between the groups. Analysis of risk factors showed no influence on the complication rate.
Conclusions:
The argument for the interrupted-suture technique is a better overview and a lower risk to grab the posterior wall during the anastomotic realization. The threads of the anterior wall can be presented individually and then be knotted.
