Bile Duct Reconstruction without T-Tube at Liver Transplantation

Park, Yeon Ho; Chang, Weon Young; Joh, Jae Won; Kim, Sung Joo; Lee, Woo Yong; Choi, Seong Ho; Lee, Suk Koo; Kim, Gaab Soo; Kim, Yu Hong; Park, Jung Eun; Cho, Hye Sool; Kim, Yong Il; Lee, Byung Boong

Abstract

BACKGROUND/AIMS: Biliary complication after orthotopic liver transplantation(OLT) continue to be a significant cause of surgical morbidity, occurring in 10~50% of patients. Bile duct obstruction and biliary leaks account for the majority of these complications. An end-to-end choledochocholedochostomy(CD) with or without T-tube or a Roux-en-Y choledochojejunostomy(CDJ) have been the standard methods of biliary reconstruction following OLT. We reviewed our experiences of OLT to assess whether or not use of the T-tube leads to increased biliary tract complications.
MATERIALS AND METHODS
From May 1996 to Feb 1998, 34 consecutive liver transplantation in 33 patients were performed at our hospital, including 12 living related liver transplantaiton. Nineteen patients were male and twenty-two patients were adult. The main indication of OLT was hepatitis B virus related cirrhosis(14 cases)in adult and biliary atresia(7 cases) in child. Four ABO incompatible cases were included in living related liver transplant. Biliary tract complications were categorized as bile leak, stenosis, or obstruction that required therapeutic intervention. Retrospective review of clinical recordings and laboratory findings were done. The median follow up periods was 10 months(range: 3~24 month).
RESULTS
The methods of biliary reconstruction in cadaveric liver transplant were CD with T-tube(n=2), CD without T-tube(n=18) and Roux-en-Y HJ(n=2), respectively. In living related liver transplant(LRLT), all 12 cases were reconstructed by Roux-en-Y CDJ without stent. Biliary tract complications were observed in one case of child LRLT patient that biliary fistula occurred at exposed bile duct on cut surface of liver. This patient underwent reoperation for constructed another HJ and progressed without complication. T-tube related complication was observed in one adult patient. T-tube was impinged at cystic duct that obstructed bile flow, intermittently. This patient was treated with insertion of PTBD catheter and removal of T-tube. No other biliary complications were detected in our series.
CONCLUSION
Performing an end-to-end CD without T-tube was a safe and effective method of reconstructing the biliary tract following hepatic transplantation in adult patients, comparing with T-tube splintage method. We concluded that routine placement of the T-tube at hepatic transplantation was considered to some selective cases, but more large scale and long -term studies were needed.