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Choledochoduodenostomy is a safe alternative to Roux-en-Y choledochojejunostomy for biliary reconstruction in liver transplantation. World J Surg 2009 May;33(5):1022-5

Date

01/16/2009

Pubmed ID

19145456

DOI

10.1007/s00268-008-9885-1

Scopus ID

2-s2.0-67349090027   23 Citations

Abstract

INTRODUCTION: Bile duct reconstruction during liver transplantation is usually performed by a duct-to-duct anastomosis or a Roux-en-Y choledochojejunostomy (CDJ). Direct anastomosis of the bile duct to the duodenum (choledochoduodenostomy-CDD) is another option for biliary reconstruction. This technique has been used with good outcome for the treatment of choledochal cysts, ampullary stenosis, and major bile duct injuries; however, there is little published experience with CDD in liver transplantation. We provide preliminary evidence that CDD is a safe technique for biliary anastomosis in liver transplant recipients.

METHODS: From September 2000 to August 2007 a total of 619 adult first-time cadaveric or living donor liver transplants were performed at the University of Colorado Health and Science Center. Bile duct repair was performed by direct end-to-end anastomosis in 466 patients and by choledocoenterostomy in the remaining 153 patients, 82 of whom were cadaveric recipients. The cadaveric choledocoenterostomy patients were divided into two groups: CDD in 25 and CDJ in 57 recipients.

RESULTS: There were no significant differences in the 1-year patient or graft survival between the cadaveric groups. The 1-year patient survival was 100% in the CDD group and 97.1% in the CDJ group. The CDD group did not experience more surgical complications compared to the CDJ group.

CONCLUSIONS: Choledochoduodenostomy is a safe alternative to CDJ biliary anastomosis when a duct-to-duct anastomosis cannot be performed. There is no significant difference in mortality, graft survival, or biliary complications. In addition, CDD offers the advantage of postoperative access to the billiary system by endoscopy and avoids complications associated with the CDJ bowel anastomosis.

Author List

Bennet W, Zimmerman MA, Campsen J, Mandell MS, Bak T, Wachs M, Kam I

Author

Michael A. Zimmerman MD, FACS Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Anastomosis, Roux-en-Y
Bile Ducts
Biliary Tract Surgical Procedures
Choledochostomy
Female
Graft Survival
Humans
Liver Transplantation
Male
Middle Aged
Postoperative Complications
Reoperation
Retrospective Studies
Treatment Outcome
jenkins-FCD Prod-486 e3098984f26de787f5ecab75090d0a28e7f4f7c0