Role of choledochojejunustomy in liver transplantation

Abstract

Objective To study the role of Roux-en-Y choledochojejunostomy in the primary biliary reconstruction during orthotopic liver transplantation(OLT) and treatment of biliary complica-tions. Methods The two modes of biliary reconstruction and biliary complications were analyzed ret-rospectively in 28 cases receiving liver transplantation between March 2003 and December 2006 in our hospital. Duct-to-duct anastomosis (group CDC) was performed in 20 patients (76.9%), and chole-dochojejunostomy (group CDJ) in 8 (23.1%). Biliary complications included stenosis, bile leakage, calculosis and extensive biliary necrosis. Results Two patients died perioperatively and 5 developed biliary complications. The overall incidence was 19.2%. There was a lower incidence of biliary com-plication among patients in the choledochojejunostomy group (27.8%) than the duct-to-duct anasto-moses (0) (P<0.05). Bile stenosis occurred in 3 patients and bile leakage occurred in 2. The treat-ments were nasobiliary drainage in 1 patient,endoscopic stenting in 1, choledochojejunostomy in 2 and retransplantation in 1. Two patients died postoperatively. Conclusion Based on our experience, the rate of complications in Roux-en-Y choledochojejunostomy is significantly lower than common duct an-astomosis. Roux-en-Y choledochojejunostomy is a useful tool both for biliary reconstruction during OLT and for posttransplantation biliary complications treatment, especially when reconstruction biliar-y blood supply insufficient and endoscopic treatment fails. Key words: Liver transplantation; Biliary reconstruction; Choledochojejunostomy; Biliary complication