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Duct-to-Duct Anastomosis Versus Bilioenteric Anastomosis for Pediatrics Living Donor Liver Transplantation: A
Beshoy Effat Elkomos1, Philopateer Alkomos2, Rao Junaid Saleem1
1General and Emergency Surgery, Northwick Park Hospital, London Northwest NHS Trust, London, GBR.
Insights
Duct-to-duct anastomosis is a safe alternative to Roux-en-Y hepaticojejunostomy in pediatric liver transplants, showing fewer complications like cholangitis. This technique offers a feasible and physiological option for pediatric living donor liver transplantation (LDLT).
Area of Science:
- Hepatobiliary Surgery
- Pediatric Transplantation
- Surgical Techniques Comparison
Background:
- Biliary complications after pediatric liver transplantation occur in over 30% of cases, posing significant challenges.
- Controversy exists regarding the safety of duct-to-duct (DD) anastomosis versus Roux-en-Y hepaticojejunostomy (RYHJ) in pediatric living donor liver transplantation (LDLT).
- Optimizing biliary reconstruction is crucial for successful pediatric LDLT outcomes.
Purpose of the Study:
- To systematically review and compare the safety and efficacy of DD anastomosis versus RYHJ in pediatric LDLT.
- To analyze rates of biliary stricture, cholangitis, overall complications, leakage, and mortality between the two techniques.
Main Methods:
- A systematic review and meta-analysis of eligible studies published between 1989 and October 2022.
- Databases searched include PUBMED, Web of Science, Scopus, and Cochrane Library.
- Seven articles involving 561 pediatric LDLT cases were included in the analysis.
Main Results:
- DD anastomosis was associated with a higher rate of biliary stricture compared to RYHJ (OR: 2.47, P = 0.01).
- RYHJ showed a higher incidence of cholangitis (OR: 0.10, P = 0.03).
- No significant differences were found in overall complication rates (OR: 1.12, P = 0.86), leakage (OR: 2.22, P = 0.13), or mortality (OR: 2.53, P = 0.30) between the two groups.
Conclusions:
- DD anastomosis is a feasible, safe, and more physiological alternative to RYHJ for pediatric LDLT.
- DD anastomosis offers a lower incidence of cholangitis and an equal overall incidence of biliary complications.
- The possibility of RYHJ conversion in cases of stricture further supports DD anastomosis as a viable option.
Abstract:
With an incidence exceeding 30%, biliary complications after pediatric liver transplantation remain a great challenge. In addition, the database includes numerous controversial papers about the safety of duct-to-duct anastomosis compared to Reux-en-Y hepaticojejunostomy for pediatric living donor liver transplantation (LDLT). We aim to compare the two techniques in pediatric LDLT by conducting a systematic review and meta-analysis. PUBMED, Web of Science, Scopus, and Cochrane Library were searched for eligible studies from 1989 to October 2022. According to our eligibility criteria, seven articles (561 pediatric LDLT) were included in our study. On one hand, DD anastomosis is associated with a higher rate of biliary stricture in comparison to RYHJ (OR: 2.47, 95% CI = 1.20-5.09, P = 0.01; I2 = 12%). On the other hand, the incidence of cholangitis was higher in RYHJ (OR: 0.10 95% CI = 0.01- 0.84, P = 0.03; I2 = 0%). However, there was no significant difference in the overall incidence of complications, leakage and mortality between the two groups (overall incidence of complication OR: 1.12, 95% CI = 0.34-3.68, P = 0.86; I2 = 62%), (Leakage OR: 2.22, 95% CI = 0.79-6.23, P = 0.13; I2 = 18%) and (Mortality OR: 2.53, 95% CI = 0.61-10.57, P = 0.30; I2 = 0%). In conclusion, with a lower incidence of cholangitis, an equal overall incidence of biliary complication, and the possibility of RY conversion in case of stricture, DD anastomosis offers a feasible, safe, and more physiological alternative to RYHJ for pediatric LDLT.
