Impact of bile duct reconstructing by Roux-en-Y choledochojejunostomy to patients with biliary complications after liver transplantation

Abstract

Objective To investigate the impact of reconstructing bile duct by Roux-en-Y choledochojejunostomy during liver transplantation on postoperative biliary complications. Methods This retrospective study included 765 patients who underwent orthotopic liver transplant at the Liver Transplantation Center of the Third Affiliated Hospital of Sun Yat-sen University from October 2003 to July 2009. Local ethical committee approval was received and that the informed consent of all participating subjects was obtained. According to the bile duct reconstruction techniques, the patients were divided into 2 groups with 713 patients receiving duct-to-duct choledochocholedochostomy and 52 patients of Roux-en-Y choledochojejunostomy. The overall incidences of biliary complications such as bile leakage, biliary stricture and lithiasis/sludge were compared by χ2 test. Results One-hundred and thirty-two of the 765 patients suffered biliary complications. The overall morbility of biliary complications including bile leakage, biliary stricture as well as biliary lithiasis/sludge were 17.3%(132/765), 2.4%(18/765), 16.3%(125/765) and 4.6%(35/765) respectively. The incidences of bile leakage, biliary stricture and lithiasis/sludge were 6%(3/52), 21%(11/52) and 8%(4/52) respectively in the patients with Roux-en-Y hepaticojejunostomy, and 2%(15/713), 16% (114/713) and 4%(31/713) respectively in the patients with duct-to-duct choledochocholedochostomy. There was no significant difference between 2 groups (all in P>0.05) . The proportions of anastomotic strictures and non anastomotic strictures between 2 groups demonstrated no significant difference (χ2=0.374, 2.661; all in P>0.05) . Conclusions Compared with the duct-to-duct choledochocholedochostomy, Roux-en-Y choledochojejunostomy during liver transplantation does not increase the incidence of postoperative biliary complications. Both techniques are effective in reconstructing bile duct. Roux-en-Y choledochojejunostomy is a useful supplementary method for duct-to-duct choledochocholedochostomy in liver transplantation. Key words: Liver transplantatation; Duct-to-duct choledochocholedochostomy; Roux-en-Y choledochojejunostomy; Biliary complications