REOPERATION FOR BILIARY-TRACT COMPLICATIONS FOLLOWING ORTHOTOPIC LIVER-TRANSPLANTATION

Biliary tract complications were analysed after 54 orthotopic liver tr ansplantations performed in 49 patients over a 2-year period. Reconstr uction of the bile duct consisted of end-to-end choledochocholedochost omy over a T tube in 47 cases and Roux-en-Y choledochojejunostomy in s even (two for sclerosing cholangitis, one for secondary biliary cirrho sis, four retransplants). The T tube was withdrawn 12-16 weeks after o peration in all but two patients (2-3 weeks). There was no intraoperat ive mortality. Eight patients (16 per cent) died during the first mont h and the 1-year actuarial survival rate was 75 per cent. Early biliar y complications (up to 3 months after operation) consisted of five bil omas, for which ultrasonographically guided drainage was effective in three and surgical drainage necessary in two. Late biliary complicatio ns (3 months onwards) consisted of biliary peritonitis following T tub e removal (four patients; reoperation was required in all four) and ne crosis of the bile duct secondary to a late arterial thrombosis (one). The incidence of reoperation as a result of early biliary complicatio ns was low (two patients), but higher for biliary peritonitis followin g T tube removal.