Roux-en-Y hepatojejunostomy combined with hilar plate in the treatment of ischemic-type biliary lesion after liver transplantation

Abstract

Objective To investigate the efficacy of Roux-en-Y hepatojejunostomy combined with hilar plate in the treatment of ischemic-type biliary lesion (ITBL) after liver transplantation. Methods Clinical data of 3 patients with ITBL (2 males and 1 females; 24-, 34-, 36 years of age; 34 years of mean age) successively admitted in the Third Affiliated Hospital of Sun Yat-Sen University from October 2008 to December 2009 were analyzed retrospectively. All Patients signed the informed consent and the ethics committee approval was recieved. The 3 patients, with the main symptoms of obstructive jaundice, developed ITBL at 14 months(Case 1), 3 years (Case 2) and 18 months (Case 3) after liver transplantation respectively. Ischemic bile duct lesions mainly located the left and right hepatic duct and confluence (limited in the hepatic hilar). Roux-en-Y hepatojejunostomy combined with hilar plate was performed on these 3 patients. The patients received regular follow-up visits after discharge. The intraoperative, postoperative complications and prognosis were observed. Results The operations were successful and all the 3 patients recovered well. No surgery-related complications such as bile leakage, intestinal leakage were found. Case 1 suffered ITBL 2 years and 9 months later due to ischemic intrahepatic biliary tract lesions progress and planned to undergo liver retransplantation. Case 2 was followed for 3 years and in stable condition. Case 3 gave up treatment for serious ITBL 6 months later. Conclusions Roux-en-Y hepatojejunostomy combined with hilar plate offers a good therapeutic alternative for ITBL when the lesions are limited in the hepatic hilar. It could postpone or avoid liver retransplantation. Key words: Liver transplantation; Postoperative complication; Biliary tract diseases; Roux-en-Y hepatojejunostomy; Hilar plate