Novel Biliary Reconstruction Techniques During Liver Transplantation
Ian C Carmody1, John Romano2, Humberto Bohorquez1
1Multi-Organ Transplant Institute, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner Journal
|March 24, 2017
Summary
Biliary transposition is a safe and effective method for liver transplant biliary reconstruction, especially when donor and recipient bile ducts differ in size. This technique avoids reoperations for biliary complications.
Area of Science:
- Hepatobiliary Surgery
- Transplantation Surgery
- Surgical Oncology
Background:
- Biliary complications are a major challenge after liver transplantation.
- Significant size discrepancies between donor and recipient bile ducts necessitate specific surgical techniques for biliary anastomosis.
Purpose of the Study:
- To compare the efficacy of biliary transposition versus recipient biliary ductoplasty in cadaveric liver transplantation.
- To evaluate outcomes in managing size mismatch between donor and recipient bile ducts.
Main Methods:
- A retrospective review of 33 liver transplants performed between 2005 and 2013.
- Comparison of biliary transposition (n=23) and biliary ductoplasty (n=10) techniques.
- Analysis of stent usage, immunosuppression protocols, and follow-up duration.
Main Results:
- Biliary transposition group had no reoperations for biliary complications.
- Two patients in the biliary transposition group required endoscopic retrograde cholangiography for stricture.
- The biliary ductoplasty group experienced three anastomotic leaks and two reoperations for biliary complications.
Conclusions:
- Both biliary transposition and biliary ductoplasty are viable options for biliary reconstruction in liver transplantation.
- Biliary transposition demonstrated a lower rate of reoperation and complications compared to ductoplasty in this cohort.
- These techniques are crucial for addressing significant donor-recipient bile duct diameter mismatches.
