INFECTION-RATES WITH AND WITHOUT T-TUBE SPLINTAGE OF COMMON BILE-DUCTANASTOMOSIS IN LIVER-TRANSPLANTATION

Stenting the bile duct over a T-tube after orthotopic liver transplant ation (OLT) is the preferred method of biliary reconstruction. However , because of complications associated with the use of the T-tube, we e valuated the effect of various biliary anastomoses following 100 conse cutive OLT (83 records were available for long-term evaluation) and as sessed the clinical outcome of abandoning routine T-tube splintage. Of 16 OLT recipients with T-tube splintage (one died immediately followi ng OLT and was excluded from the study), 6 patients (40 %) developed s ix episodes of septicaemia secondary to biliary and/or intra-abdominal sepsis. Four of these six patients had a biliary leak (27 %). Of 57 p atients with duct-to-duct anastomosis without T-tube splintage, 7 pati ents developed biliary leak (12.3 %) and only 1 developed septicaemia (1.7 %) secondary to biliary and intra-abdominal sepsis (P = 0.0002). Of 11 patients with either a gallbladder conduit or Roux loop, only 1 patient had a biliary leak (9 %) and there were no septicaemic episode s. In conclusion, direct duct-to-duct anastomosis resulted in signific antly less morbidity due to infection without T-tube splintage than th e use of a T-tube following OLT, but there were no significant differe nces in leakage and stricture rates.