Abstract
Biliary anastomoses in Orthotopic liver transplantation (OLT) are considered technically arduous and are accountable for the majority of OLT surgical complications. In this ‘How I do It’ article, we present a new biliary anastomosis technique. It has been performed in our service since 2011 in more than 300 liver transplants. In our series, 5.7% of the patients submitted to duct-to-duct anastomosis with a follow-up greater of 6 months developed biliary complications. Future studies should enhance this surgical technique, in order to minimize the OLT complications.
Highlights
In the past several years, orthotopic liver transplantation (OLT) techniques have been greatly improved, dramatically reducing OLT mortality rates [1,2].biliary anastomosis still remains the “Achilles’ heel of OLT”, being responsible for the majority of OLT surgical complications [2]
Since OLT complications are frequently related to biliary anastomosis and the majority of these complications are associated with surgical technique OLT surgeons must improve their anastomosis skills to reduce the incidence of biliary complications [2,3,4,9]
5.7% of the patients submitted to duct-to-duct anastomosis with a follow-up greater of 6 months developed biliary complications
Summary
In the past several years, orthotopic liver transplantation (OLT) techniques have been greatly improved, dramatically reducing OLT mortality rates [1,2]. Biliary reconstruction during OLT is generally performed by endto-end choledocho-choledochostomy (CC) or Roux-Y choledochojejunostomy (CRY). Both are considered standard techniques [5]. Since OLT complications are frequently related to biliary anastomosis and the majority of these complications are associated with surgical technique OLT surgeons must improve their anastomosis skills to reduce the incidence of biliary complications [2,3,4,9]. A “w” figure is formed in the 9 o’clock suture This keeps the two edges of the bile duct separated from each other. The posterior wall of the bile duct is sewed from inside the lumen with a running suture until reaching the 9 o’clock end (Figure 1b). The posterior and anterior running sutures as well as the 9 o’clock suture are tied up to complete the anastomosis (Figure 1d)
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