Jens Mittler1, Kenneth D Chavin2, Stefan Heinrich3, Roman Kloeckner4, Tim Zimmermann5, Hauke Lang3. 1. Department of General, Visceral, and Transplant Surgery, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. jens.mittler@unimedizin-mainz.de. 2. University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5047, USA. 3. Department of General, Visceral, and Transplant Surgery, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. 4. Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany. 5. First Medical Department, University Medical Center Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
Abstract
BACKGROUND: Bilio-enteric diversion is the current surgical standard in patients after deceased donor liver transplantation (DDLT) with a biliary anastomotic stricture failing interventional treatment and requiring surgical repair. In contrast to this routine, the aim of this study was to show the feasibility and safety of a duct-to-duct biliary reconstruction. PATIENTS: Between 2012 and 2019, we performed a total of 308 DDLT in 292 adult patients. The overall biliary complication rate was 20.5%. Patients with non-anastomotic or combined strictures were excluded from this analysis. Out of 273 patients after a primary duct-to-duct reconstruction, 20 (7.3%) developed late isolated AS. Seven of these patients failed interventional biliary treatment and required a surgical repair. RESULTS: Duct-to-duct reconstruction was feasible and successful in all patients. Liver function tests fully normalized and no patient required any form of biliary intervention after surgery. One patient with intraoperative cholangiosepsis was ICU bound for 5 days, and another patient with a subhepatic abscess required percutaneous drainage. There was no perioperative death. The median length of hospital stay was 8 (5-17) days. The median time of follow-up after relaparotomy was 1593 (434-2495) days. CONCLUSION: Duct-to-duct reconstruction is a feasible and safe option in selected patients requiring surgical repair for isolated AS after DDLT. This approach preserves the biliary anatomy and avoids the potential side effects of a bilio-enteric diversion.
BACKGROUND: Bilio-enteric diversion is the current surgical standard in patients after deceased donor liver transplantation (DDLT) with a biliary anastomotic stricture failing interventional treatment and requiring surgical repair. In contrast to this routine, the aim of this study was to show the feasibility and safety of a duct-to-duct biliary reconstruction. PATIENTS: Between 2012 and 2019, we performed a total of 308 DDLT in 292 adult patients. The overall biliary complication rate was 20.5%. Patients with non-anastomotic or combined strictures were excluded from this analysis. Out of 273 patients after a primary duct-to-duct reconstruction, 20 (7.3%) developed late isolated AS. Seven of these patients failed interventional biliary treatment and required a surgical repair. RESULTS: Duct-to-duct reconstruction was feasible and successful in all patients. Liver function tests fully normalized and no patient required any form of biliary intervention after surgery. One patient with intraoperative cholangiosepsis was ICU bound for 5 days, and another patient with a subhepatic abscess required percutaneous drainage. There was no perioperative death. The median length of hospital stay was 8 (5-17) days. The median time of follow-up after relaparotomy was 1593 (434-2495) days. CONCLUSION: Duct-to-duct reconstruction is a feasible and safe option in selected patients requiring surgical repair for isolated AS after DDLT. This approach preserves the biliary anatomy and avoids the potential side effects of a bilio-enteric diversion.
Authors: Robert Sutcliffe; Donal Maguire; Andrej Mróz; Bernard Portmann; John O'Grady; Matthew Bowles; Paolo Muiesan; Mohamed Rela; Nigel Heaton Journal: Liver Transpl Date: 2004-07 Impact factor: 5.799
Authors: Andreas Weber; Christian Prinz; Carlos Gerngross; Leopold Ludwig; Wolfgang Huber; Bruno Neu; Matthias P Ebert; Alexander Meining; Hans Weidenbach; Roland M Schmid; Ewert Schulte-Frohlinde Journal: J Gastroenterol Date: 2009-09-09 Impact factor: 7.527