Mohamed Bekheit1, Matteo Catanzano2, Stuart Shand3, Irfan Ahmed4, ELSaid ELKayal5, Gihan Mohamed Shehata6, Adel Zaki6. 1. Center of Liver Surgery and Transplantation, Paul Brousse Hospital, University of Paris-Sud, Villejuif Cedex, France; Medical Research Institute, University of Alexandria, Alexandria, Egypt; HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK; Department of Surgery, Elkabbary General Hospital, Alexandria, Egypt; University of Aberdeen, Aberdeen, UK. Electronic address: Dr_mohamedbekheit@hotmail.com. 2. University of Aberdeen, Aberdeen, UK. 3. HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK. 4. HPB Surgery Unit Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK; University of Aberdeen, Aberdeen, UK. 5. Department of Surgery, Alexandria Main University Hospital, Faculty of Medicine, Alexandria, Egypt. 6. Medical Research Institute, University of Alexandria, Alexandria, Egypt.
Abstract
BACKGROUND: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion (sequential) versus simultaneous or initial artery reperfusion. DATA SOURCES: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. RESULTS: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures (OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group (OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. CONCLUSIONS: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.
BACKGROUND: Liver transplant is a potential cure for liver failure and hepatic malignancy but there are many techniques which have been described for vascular reconstruction. This study was to compare the prevalence of non-anastomotic biliary stricture and other surgical complications based on Clavien-Dindo scoring system, in initial portal reperfusion (sequential) versus simultaneous or initial artery reperfusion. DATA SOURCES: Meta-analysis of published studies comparing the outcomes of both techniques was carried out. Data search was conducted across the major databases and studies were selected under the guidance of the Cochrane guidelines for systematic reviews and meta-analysis. RESULTS: Seven studies were included to address the primary and the secondary outcomes. No statistical difference was found in the incidence of non-anastomotic biliary strictures (OR = 0.40; P = 0.14), regardless of reperfusion technique. The pooled estimate of the Clavien-Dindo grading of complications was not significantly different between the techniques, though Clavien-Dindo II complications were higher in the simultaneous or initial artery reperfusion group than the initial portal reperfusion group (OR = 2.73; P = 0.01). Similarly, there was no difference in the operative time, hospital stay and other outcomes addressed in this report. CONCLUSIONS: The available evidence suggests that there is no significant difference demonstrated in the rate of non-anastomotic biliary strictures or other complications, between the two techniques, except for Clavien-Dindo II complications.