BILIARY-TRACT COMPLICATIONS OF SIDE-TO-SIDE WITHOUT T-TUBE VERSUS END-TO-END WITH OR WITHOUT T-TUBE CHOLEDOCHOCHOLEDOCHOSTOMY IN LIVER-TRANSPLANT RECIPIENTS

Background, Biliary anastomotic complications remain a major cause of morbidity in liver transplant recipients, ranging between 10% and 50% in large clinical series, An end-to-end choledochocholedochostomy with or without T tube (CDCD EE with T tube and CDCD EE w/o T tube) and a Roux-en Y choledochojejunostomy have been standard methods for biliary drainage, Methods. The objectives of this retrospective study were to : (1) evaluate the incidence of biliary tract complications using a ne w method of side-to-side choledochocholedochostomy without T tube (CDC D SS w/o T tube) and (2) compare the results of CDCD SS w/o T tube wit h those of CDCD EE with T tube and CDCD EE w/o T tube, From September 1991 through June 1996, 279 orthotopic liver transplants were performe d in 268 patients and followed through December 1996 (minimum of 6 mon ths' follow-up). A total of 227 CDCD anastomoses in 220 patients were studied (7 retransplants >30 days): CDCD EE with T tube (n=124), CDCD EE w/o T tube (n=44), and CDCD SS w/o T tube (n=59). Results. Sixty-ni ne biliary complications were observed in 220 patients (30%). Anastomo tic and/or T-tube leaks were seen in 43 patients (19%), and anastomoti c strictures were found in 26 patients (12%). Forty patients (18%) req uired percutaneous or endoscopic stent placement (6%) or surgical inte rventions (12%). CDCD EE with T tube had the highest incidence of bili ary leak requiring rehospitalization but the lowest anastomotic strict ure and intervention rate and the lowest B-month mortality rate, Concl usions, CDCD EE with T tube was superior to CDCD EE or CDCD SS w/o T t ube despite the increased number of rehospitalizations. CDCD SS w/o T tube did not offer significant advantages over conventional biliary an astomotic techniques.