Authors:	Mittler, Jens Chavin, Kenneth D. Kloeckner, Roman Zimmermann, Tim Lang, Hauke
Title:	Surgical duct-to-duct reconstruction : an alternative approach to late biliary anastomotic stricture after deceased donor liver transplantation
Online publication date:	26-May-2021
Year of first publication:	2021
Language:	english
Abstract:	BACKGROUND Bilio-enteric diversion is the current surgical standard in patients after deceased donor liver transplantation (DDLT) with a biliary anastomotic stricture failing interventional treatment and requiring surgical repair. In contrast to this routine, the aim of this study was to show the feasibility and safety of a duct-to-duct biliary reconstruction. PATIENTS Between 2012 and 2019, we performed a total of 308 DDLT in 292 adult patients. The overall biliary complication rate was 20.5%. Patients with non-anastomotic or combined strictures were excluded from this analysis. Out of 273 patients after a primary duct-to-duct reconstruction, 20 (7.3%) developed late isolated AS. Seven of these patients failed interventional biliary treatment and required a surgical repair. RESULTS Duct-to-duct reconstruction was feasible and successful in all patients. Liver function tests fully normalized and no patient required any form of biliary intervention after surgery. One patient with intraoperative cholangiosepsis was ICU bound for 5 days, and another patient with a subhepatic abscess required percutaneous drainage. There was no perioperative death. The median length of hospital stay was 8 (5–17) days. The median time of follow-up after relaparotomy was 1593 (434–2495) days. CONCLUSION Duct-to-duct reconstruction is a feasible and safe option in selected patients requiring surgical repair for isolated AS after DDLT. This approach preserves the biliary anatomy and avoids the potential side effects of a bilio-enteric diversion.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-5916
Version:	Published version
Publication type:	Zeitschriftenaufsatz
License:	CC BY
Information on rights of use:	https://creativecommons.org/licenses/by/4.0/
Journal:	Journal of gastrointestinal surgery 25
Pages or article number:	708 712
Publisher:	Springer
Publisher place:	New York, NY
Issue date:	2021
ISSN:	1873-4626
Publisher URL:	https://doi.org/10.1007/s11605-020-04735-y
Publisher DOI:	10.1007/s11605-020-04735-y
Appears in collections:	JGU-Publikationen