OBJECTIVE: To compare the incidence of biliary complications after liver transplantation in patients undergoingcholedochocholedochostomy reconstruction with or without T tube in a multicenter, prospective, randomized trial. SUMMARY BACKGROUND DATA: Several reports have suggested that biliary anastomosis without a T tube is a safe method of biliary reconstruction that could avoid complications related to the use of T tubes. No large prospective randomized trial has so far been published to compare the two techniques. METHODS:One hundred eighty recipients of orthotopic liver transplantation were randomly assigned to choledochocholedochostomy with (n = 90) or without (n = 90) a T tube in six French liver transplantation centers. All types of biliary complications were taken into account. RESULTS: The overall biliary complication rate was increased in the T-tube group, even though these complications did not lead to an increase in surgical or radiologic therapeutic procedures. The major significant complication was cholangitis in the T-tube group; this did not occur in the other group. The incidence of biliary fistula was 10% in the T-tube group and 2.2% in the group without a T tube. Other biliary complications were similar. The complication rate of cholangiography performed with the T tube was greater than with other types of biliary exploration. The graft and patient survival rates were similar in the two groups. CONCLUSION: This study is the first large prospective, randomized trial of biliary complications with or without a T tube. The authors found an increase in the biliary complication rate in the T-tube group, which was linked to minor complications. The T tube did not provide a safer access to the biliary tree compared with the others types of biliary explorations. The authors recommend the performance of choledochocholedochostomy without a T tube in liver transplantation.
RCT Entities:
OBJECTIVE: To compare the incidence of biliary complications after liver transplantation in patients undergoing choledochocholedochostomy reconstruction with or without T tube in a multicenter, prospective, randomized trial. SUMMARY BACKGROUND DATA: Several reports have suggested that biliary anastomosis without a T tube is a safe method of biliary reconstruction that could avoid complications related to the use of T tubes. No large prospective randomized trial has so far been published to compare the two techniques. METHODS: One hundred eighty recipients of orthotopic liver transplantation were randomly assigned to choledochocholedochostomy with (n = 90) or without (n = 90) a T tube in six French liver transplantation centers. All types of biliary complications were taken into account. RESULTS: The overall biliary complication rate was increased in the T-tube group, even though these complications did not lead to an increase in surgical or radiologic therapeutic procedures. The major significant complication was cholangitis in the T-tube group; this did not occur in the other group. The incidence of biliary fistula was 10% in the T-tube group and 2.2% in the group without a T tube. Other biliary complications were similar. The complication rate of cholangiography performed with the T tube was greater than with other types of biliary exploration. The graft and patient survival rates were similar in the two groups. CONCLUSION: This study is the first large prospective, randomized trial of biliary complications with or without a T tube. The authors found an increase in the biliary complication rate in the T-tube group, which was linked to minor complications. The T tube did not provide a safer access to the biliary tree compared with the others types of biliary explorations. The authors recommend the performance of choledochocholedochostomy without a T tube in liver transplantation.
Authors: J Nuño; E Vicente; V S Turrión; F Pereira; J Ardaiz; V Cuervas; R Bárcena; M García; A L San Roman; A Candela; A Honrubia; A Moreno Journal: Transplant Proc Date: 1997 Feb-Mar Impact factor: 1.066
Authors: M C Shuhart; K V Kowdley; J P McVicar; C A Rohrmann; M F McDonald; D W Wadland; S S Emerson; R L Carithers; M B Kimmey Journal: Liver Transpl Surg Date: 1998-01
Authors: A S Klein; S Savader; J F Burdick; J Fair; M Mitchell; P Colombani; B Perler; F Osterman; G M Williams Journal: Hepatology Date: 1991-11 Impact factor: 17.425
Authors: R J Stratta; R P Wood; A N Langnas; R R Hollins; K J Bruder; J P Donovan; D A Burnett; R P Lieberman; G B Lund; T J Pillen Journal: Surgery Date: 1989-10 Impact factor: 3.982
Authors: Alban Denys; Patrick Chevallier; Francesco Doenz; Salah D Qanadli; Daniel Sommacale; Michel Gillet; Pierre Schnyder; Bertrand Bessoud Journal: Eur Radiol Date: 2004-01-09 Impact factor: 5.315
Authors: R Girometti; C Molinari; M Del Pin; P Toniutto; D Bitetto; G Como; C Zuiani; M Bazzocchi Journal: Radiol Med Date: 2012-03-19 Impact factor: 3.469
Authors: Shawn St Peter; Manuel I Rodriquez-Davalos; Hector M Rodriguez-Luna; Edwyn M Harrison; Adyr A Moss; David C Mulligan Journal: Dig Dis Sci Date: 2004-08 Impact factor: 3.199