C M García Bernardo1, I González-Pinto Arrillaga2, A Miyar de León2, V Cadahia Rodrigo3, L González Dieguez3, L Barneo Serra2, L Vázquez Velasco2. 1. Department of General Surgery (HPB and Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain. Electronic address: cmgbernardo2@hotmail.com. 2. Department of General Surgery (HPB and Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain. 3. Department of Digestive Diseases (Liver Transplant Unit), University Hospital Central of Asturias (HUCA), University of Oviedo, Oviedo, Spain.
Abstract
OBJECTIVES: The authors sought to check the frequency of biliary complications with the use of a T-tube. In 2012, throughout the year, it was carried out systematically in all liver transplantations regardless of the characteristics of the bile duct. Despite the long experience, biliary complications remain a common cause of postoperative morbidity and mortality. MATERIAL AND METHODS: In this study we compared complications in 23 consecutive transplantation cases using T-tube biliary anastomosis during the year 2012 with 23 consecutive transplantation cases without T-tube during the year 2013. We evaluated postoperative complications and long-term outcomes (for 2 years to 3 years). RESULTS: Of the 23 patients with anastomosis with a T-tube, 2 patients (8.69%) had biliary stricture that required prosthesis by endoscopic retrograde cholangiopancreatography, 1 of them (4.34%) was operated by incorrect placement of the T-tube, and in 4 patients (17.39%) bile leakage (endoscopic retrograde cholangiopancreatography prostheses in 3 cases and hepaticojejunostomy in 1). During follow-up at 3 years, only 2 patients had minimal bile duct dilatation without clinical relevance. In the patients who underwent transplantation without a T-tube, 18 (78.26%) had no complications, 3 (13.04%) showed stenosis (prosthesis placement), and 2 (8.69%) had bile leakage (hepaticojejunostomy and prosthesis). During follow-up at 2 years to 3 years, no patient had biliary dilatation or alteration of cholestatic parameters. In the comparative study of both groups we found no statistically significant differences. CONCLUSIONS: We have not seen an improvement in complications with the use of T-tube (69.56% vs. 78.23%) that encourage us to work systematically, although the small number of cases does not allow statistically significant conclusions. Copyright Â
OBJECTIVES: The authors sought to check the frequency of biliary complications with the use of a T-tube. In 2012, throughout the year, it was carried out systematically in all liver transplantations regardless of the characteristics of the bile duct. Despite the long experience, biliary complications remain a common cause of postoperative morbidity and mortality. MATERIAL AND METHODS: In this study we compared complications in 23 consecutive transplantation cases using T-tube biliary anastomosis during the year 2012 with 23 consecutive transplantation cases without T-tube during the year 2013. We evaluated postoperative complications and long-term outcomes (for 2 years to 3 years). RESULTS: Of the 23 patients with anastomosis with a T-tube, 2 patients (8.69%) had biliary stricture that required prosthesis by endoscopic retrograde cholangiopancreatography, 1 of them (4.34%) was operated by incorrect placement of the T-tube, and in 4 patients (17.39%) bile leakage (endoscopic retrograde cholangiopancreatography prostheses in 3 cases and hepaticojejunostomy in 1). During follow-up at 3 years, only 2 patients had minimal bile duct dilatation without clinical relevance. In the patients who underwent transplantation without a T-tube, 18 (78.26%) had no complications, 3 (13.04%) showed stenosis (prosthesis placement), and 2 (8.69%) had bile leakage (hepaticojejunostomy and prosthesis). During follow-up at 2 years to 3 years, no patient had biliary dilatation or alteration of cholestatic parameters. In the comparative study of both groups we found no statistically significant differences. CONCLUSIONS: We have not seen an improvement in complications with the use of T-tube (69.56% vs. 78.23%) that encourage us to work systematically, although the small number of cases does not allow statistically significant conclusions. Copyright Â