Elsevier

Transplantation Proceedings

Volume 37, Issue 9, November 2005, Pages 3922-3923
Transplantation Proceedings

Outcome
Preliminary Study of Choledochocholedochostomy Without T Tube in Liver Transplantation: A Comparative Study

https://doi.org/10.1016/j.transproceed.2005.10.047Get rights and content

Abstract

Introduction

Biliary anastomosis during liver transplantation can be safely performed using an end-to-end choledochocholedochostomy, with or without a T tube. The objective of this study was to determine whether the insertion of a T tube was related to more postoperative complications.

Methods

Between April 1986 and September 2004, we performed a retrospective, longitudinal, and comparative study of 1012 liver transplantations, including 50 adult recipients with a T tube and a control group with a choledochocholedochostomy without a T tube.

Results

T tube insertion was associated with more postoperative complications and worse actuarial survival of both the recipient and graft, though these differences did not reach statistical significance.

Conclusion

The duct-to-duct biliary anastomosis stented with a T tube tends to be associated with more postoperative complications. Based on this analysis, we recommend the performance of a nonstented anastomosis.

Section snippets

Methods

Between April 1986 and September 2004, we performed a retrospective, longitudinal and comparative study on our 1012 liver transplantations. We have selected 50 adult recipients carrying a T tube for comparison with a control group who underwent a choledochocholedochostomy without a T tube. Mean recipient age was 51.93 ± 9.78 years, and 71% were males. According to Child-Pugh classification, 52% were stage C, 35% stage B, and 13% stage A. The indication for liver transplantation was

Biliary Complications (n = 16)

Complications included ischemic cholangiopathy related to hepatic artery thrombosis (3), cholangitis (6), choledocholithiasis (1), anastomotic stricture (7), bile leak at the T tube insertion (1), biliary peritonitis after T tube removal (1), incidental T tube removal (2), ischemic cholangiopathy (3), anastomotic structure related to arterial thrombosis (4), and need for hepaticojejunostomy (7). In two cases, the complications were resolved through PTC.

Retransplant (n = 4)

Reasons included gallbladder cancer in the

Discussion

Primary biliary anastomosis stented with a T tube has been used as the standard technique for biliary reconstruction in liver transplantation. Its advantages have been fully described.1 Some authors have also described more biliary complications when a T tube was not used, recommending a stented anastomosis after liver transplantation.2

Nevertheless, specific complications related to the T tube have been associated with this procedure,3 mainly bile leak, cholangitis, bile obstruction, tube

References (5)

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