Choledochoduodenostomy in Liver Transplantation.

Abstract

Biliary complications are frequent after liver transplantation and the method of biliary reconstruction is an important factor in this context. When duct-to-duct biliary anastomosis is not applicable, traditionally choledochojejunostomy (CJS) has been the method of choice. Choledochoduodenostomy (CDS) has emerged as an alternative technique with several potential benefits. We performed a retrospective cohort-study of all CDS-procedures (n=63) performed in our hospital from 2009 to 2013, comparing them to a cohort of CJS-procedures (n=63) from 2006 to 2009. Demographical data, patient and graft survival, and biliary complications were recorded. One-year patient and graft survival was similar in the two groups. The rate of biliary leaks (10/10, p=0,96) and anastomotic stenosis (2/3, p=0,66) were equal. 12 patients in the CDS group were subject to endoscopic retrograde cholangiography whereas 6 patients in the CJS group had double-balloon enteroscopy performed. Biliary anastomotic complications tended to be resolved endoscopically more often in the CDS-group compared to CJS, but this was not statistically significant (8/4, p=0,21). A trend towards increased risk of cholangitis was observed with CDS, although statistical significance was not reached (14/7, p=0,07). We conclude that CDS is an attractive alternative to CJS in liver transplantation. CDS is easily performed and favors endoscopic access to the biliary tree for diagnostic and therapeutic interventions. This can potentially reduce the rate of reoperations and patient morbidity, although CDS may increase the risk of cholangitis.