Duct-to-duct biliary reconstruction in orthotopic liver transplantation for primary sclerosing cholangitis: a viable and safe alternative
| Autor: | Andrew K. Burroughs, Dinesh K. Sharma, Brian R. Davidson, Nancy Rolando, Osama Damrah, Keith Rolles, Bimbi Fernando |
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| Rok vydání: | 2011 |
| Předmět: |
Transplantation
medicine.medical_specialty Orthotopic liver transplantation Common bile duct business.industry Anastomosis medicine.disease digestive system Gastroenterology Surgery Primary sclerosing cholangitis surgical procedures operative medicine.anatomical_structure Internal medicine medicine Graft survival Biliary Tract Surgical Procedures business Duct (anatomy) |
| Zdroj: | Transplant International. 25:64-68 |
| ISSN: | 0934-0874 |
| DOI: | 10.1111/j.1432-2277.2011.01371.x |
| Popis: | Roux-en-Y loop is considered the reconstruction method of choice in Orthotopic Liver Transplantation (OLT) for Primary Sclerosing Cholangitis (PSC). We have adopted an approach of duct-to-duct (D-D) reconstruction when recipient common bile duct is free of gross disease. Patients were divided into two groups: patients who underwent a Roux-en-Y choledochojejunostomy and patients who had a D-D anastomosis. Morbidity, mortality, disease recurrence and graft and patient survival were compared between the two groups and analyzed. Ninety-one patients had OLT for PSC. Sixty-three patients underwent a D-D biliary reconstruction, whereas 28 patients had a Roux-en-Y loop. Biliary leak complicated 8% from the D-D group, and 14% from the Roux-en-Y group (P = 0.08), whereas biliary strictures were identified in 10% vs. 7% patients from the D-D and Roux-en-Y group, respectively (P = 0.9). Actuarial 1, 3 and 10 year survival for D-D and Roux-en-Y group was (87%, 80% and 62%) and (82%, 73% and 73%), respectively (P = 0.7). The corresponding 1, 3 and 10 year graft survival was (72%, 58% and 42%) and (67%, 58% and 53%), respectively (P = 0.6). No difference was seen in disease recurrence rates. D-D biliary reconstruction in OLT for selected PSC patients remains our first option of reconstruction. |
| Databáze: | OpenAIRE |
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