Choledochocholedochostomy without a T tube or internal stent in transplantation of the liver

Abstract

Different techniques have been used for biliary reconstruction in transplantation of the liver. Early techniques of cholecystodoudenostomy and cholecystojejunostomy had high rates of biliary complications often with associated mortality. Today, most centers use a choledochocholedochostomy with a T tube (CC-T) or Roux-en-Y choledochojejunostomy (RYCJ) for biliary reconstruction in hepatic transplantation with a low mortality rate but still significant morbidity. In our early experience at the University of Chicago, we used CC-T as the procedure of choice and RYCJ in the remaining instances. However, it was noted that a large number of biliary complications in the CC-T group were related to the use of T tubes, which prompted us to consider the use of primary anatomosis without tube drainage or stenting (CC). We reviewed 136 transplants with a graft survival rate of greater than two weeks. The over-all complication rates for each group were 38 CC, 18 per cent; 26 CC-T, 35 per cent, and 72 RYCJ, 21 per cent. One patient died as a direct result of a biliary complication. The main difference between CC and CC-T was early biliary complications (5 versus 31 per cent, p less than 0.02 most were T-tube related. We advocate the use of CC (without a T tube) when-possible. We recommend RYCJ whenever reoperation and biliary revision are required. We have found that both CC and RYCJ can be used safely for biliary reconstruction in hepatic transplantation.