Surgical Complications and Long‐Term Outcome of Different Biliary Reconstructions in Liver Transplantation for Primary Sclerosing Cholangitis—Choledochoduodenostomy versus Choledochojejunostomy

Choledochojejunostomy (CJS) is commonly used for biliary reconstruction in liver transplantation for primary sclerosing cholangitis (PSC). We alternatively performed choledochoduodenostomy (CDS) and side‐to‐side choledochodocholedochstomy in a large cohort of patients. Fifty‐one patients with PSC, t...

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Bibliographic Details
Published in:American journal of transplantation 2006-02, Vol.6 (2), p.379-385
Main Authors: Schmitz, V., Neumann, U. P., Puhl, G., Tran, Z. V., Neuhaus, P., Langrehr, J. M.
Format: Article
Language:English
Subjects:
Adult
Bile duct
Biological and medical sciences
Cholangitis, Sclerosing - surgery
Choledochostomy - adverse effects
Female
Gallbladder - surgery
Gastroenterology. Liver. Pancreas. Abdomen
Humans
liver transplantation
Liver Transplantation - adverse effects
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
Other diseases. Semiology
Plastic Surgery Procedures
Postoperative Complications - classification
post‐operative complications
Retrospective Studies
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
surgical complications
Treatment Outcome
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Summary:Choledochojejunostomy (CJS) is commonly used for biliary reconstruction in liver transplantation for primary sclerosing cholangitis (PSC). We alternatively performed choledochoduodenostomy (CDS) and side‐to‐side choledochodocholedochstomy in a large cohort of patients. Fifty‐one patients with PSC, transplanted between 1988 and 2000, were analyzed retrospectively. Biliary reconstruction was CDS in 25 (49%), CJS in 20 (39%) and CC in 6 transplantations (12%). Biliary leaks occurred in the early follow‐up (≤41 days) only in CDS patients (20%). However, in the late follow‐up (>4 months), stricturing of anastomosis was found once in CDS (4%) and CJS (5%). Later (>9 months), intrahepatic bile duct strictures were diagnosed in four CDS (16%), one CJS (5%) and one CC (17%) patient(s). In 48% of CDS (12/25), 60% of CJS (12/20) and 17% of CC (1/6) at least one incidence of cholangitis was observed. Overall, biliary complication rates were significantly higher in CDS (40%) than CJS (10%) and CC (17%); of those none in CC and 12% in CDS were anastomosis‐related. Graft/patient survival showed no significant differences among groups. Based on our results we consider CJS the standard method for biliary reconstruction in PSC; however, in selected cases where CJS is difficult to accomplish because of previous surgery or for retransplantation, CDS may present an alternative technique.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2005.01173.x